Shintaro Honda1, Shunsuke Fujibayashi2, Takayoshi Shimizu2, Naoya Tsubouchi3, Yusuke Kanba4, Takashi Sono5, Hiroaki Kimura6, Seichi Odate7, Eijiro Onishi8, Yasuyuki Tamaki9, Takuya Tomizawa10, Ryosuke Tsutsumi11, Ko Yasura12, Koichi Murata2, Bungo Otsuki2, Shuichi Matsuda2. 1. Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan. s_honda726@kuhp.kyoto-u.ac.jp. 2. Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan. 3. Department of Orthopedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 4. Department of Orthopedic Surgery, Japan Community Health Care Organization Tamatsukuri Hospital, Shimane, Japan. 5. Department of Orthopedic Surgery, Fukui Red Cross Hospital, Fukui, Japan. 6. Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan. 7. Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan. 8. Department of Orthopedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. 9. Department of Orthopedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan. 10. Department of Orthopedic Surgery, Tenri Hospital, Nara, Japan. 11. Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan. 12. Department of Orthopaedic Surgery, Otsu Red Cross Hospital, Shiga, Japan.
Abstract
PURPOSE: This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI). METHODS: We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission. RESULTS: Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition. CONCLUSIONS: In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention.
PURPOSE: This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI). METHODS: We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission. RESULTS: Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition. CONCLUSIONS: In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention.