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Journal of Neurosurgical Sciences 2020 February;64(1):44-51

DOI: 10.23736/S0390-5616.17.03975-3


language: English

Factors predicting outcome of surgical treatment of spontaneous spinal hematomas: a retrospective cohort study in four tertiary reference centers

Rafael MARTÍNEZ-PÉREZ , Igor PAREDES 2, Natalia RAYO 3, Pedro de la ROSA 4, Jorge D. MOLINA 5, Alfonso LAGARES 2

1 Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; 2 Deparment of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain; 3 Western University, London, ON, Canada; 4 Department of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; 5 Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain

BACKGROUND: Spontaneous spinal extradural hematoma (SSEH) is a rare but disabling disorder. Most of the previous assumptions regarding the factors that contribute to poor neurological recovery from SSEH are based on small case samples or conditions with similar clinical presentations but different physiopathologies. Our goal was to find the most relevant prognostic factors for neurological recovery in patients suffering SSEH treated with surgical evacuation.
METHODS: From a retrospective database of 29 surgical patients with SSEH, several clinical and radiological variables were recorded. These variables were compared between patients with good and poor neurological recovery, considering good as an improvement by at least one point in the ASIA Scale.
RESULTS: Among the patients included, morbidity and mortality rate was 6.9% and 3.4%, respectively, with a mean follow-up of 7.1 months. Neurological full recovery was experienced by 33% of the patients included, and 86% of individuals had an improvement in their neurological condition at last follow-up. Lesser intramedullary lesions were significantly associated with greater chances of improvement in ASIA Scale at discharge and at follow-up. Surgical decompression within the first 24 hours of onset of symptoms were correlated with better neurological outcomes at follow-up.
CONCLUSIONS: MRI is a powerful tool to predict the neurological outcome in SSEH patients, and it should be considered as an another resource to better know the patients with greater chances of having neurological recovery, especially in cases where the neurological examination is not reliable at the initial exam.

KEY WORDS: Subdural space; Hematoma, subdural, spinal; Prognosis

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