title: Spinal hematoma unrelated to previous surgery: analysis of 15 consecutive cases treated in a single institution within a 10-year period.
abstract: METHODS
  Retrospective clinical study.
  
  
  OBJECTIVE
  To determine characteristics, treatment methods, and outcome in an institutional series of patients with spinal hematoma not related to previous surgery.
  
  
  METHODS
  The charts of all patients with spinal hematoma treated in our institution between January 1993 and December 2002 were reviewed and analyzed with regard to location and extension of the hematoma, duration of symptoms, neurologic status, diagnostic measures, therapy, and outcome.
  
  
  RESULTS
  Fifteen patients were identified with spinal hematomas not caused by previous spine surgery. There were 11 women and 4 men. One hematoma was located subdurally and another intramedullary. All other hematomas were extradural, with 10 spontaneous bleedings. Eight hematomas were located in the cervical, two in the cervicothoracic, and three in the thoracic region. Two others were situated in the lumbar spine. Mean extension was 4.7 segments (range, 2-8 segments). Mean interval between onset of symptoms and surgery was 18 hours (range, 8-48 hours) for 12 patients; in 2 cases, diagnosis was made after 17 and 36 days, respectively, and then treated by surgery. One patient was treated without operation. Operative treatment was accomplished in all cases by hemilaminectomy and/or interlaminar fenestration and hematoma evacuation, in those cases with a larger extension of extradural hematoma by an alternating hemilaminectomy, thus reducing the risk of postoperative instability. There was no recurrence. No correlation between time to surgery and outcome was found in this study group, but there was a strong correlation between initial neurologic status and outcome after surgery.
  
  
  CONCLUSIONS
  Nonsurgical derived spinal hematomas are rare. In this series, most cases were spontaneous and located in the cervical or cervicothoracic region producing severe neurologic deficit and pain. Treatment should be surgical evacuation in the majority. As most hematomas are of great extension, alternating hemilaminectomy suffices for evacuation of extradural hematomas and supports the stability of the spinal segments. Outcome is highly dependent from initial neurologic status.
authors.affiliation: Neurosurgical Department, University of Ulm, Günzburg, Germany. wolfgang.boerm@medizin.uni-ulm.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Börm
authors.forename: Klaus
authors.initials: K
authors.lastname: Mohr
authors.forename: Uwe
authors.initials: U
authors.lastname: Hassepass
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Richter
authors.forename: Erich
authors.initials: E
authors.lastname: Kast
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D003374:Coumarins / Q000009:adverse effects; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000503:physiopathology; D009460:Neurologic Examination; D010146:Pain; D011183:Postoperative Complications; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003374:Coumarins; C030123:coumarin