title: 10 Levels thoracic no-intrumented laminectomy for huge spontaneous spinal subdural hematoma removal. Report of the first case and literature review.
abstract: BACKGROUND
  Spontaneous idiopathic acute spinal subdural hematoma (SSDH) is a rare cause of acute back pain followed by signs and symptoms of nerve root and/or spinal cord compression, frequently associated with coagulopathies, blood dyscrasias and arterio-venous malformations. Standard management includes non-operative treatment and timely (within 24h) surgical decompression.
  
  
  METHODS
  We report on the case of a huge 10 levels SSDH treated with decompressive thoracic no-instrumented laminectomy in a 45-year-old woman with good neurological recovery (from ASIA A to D).
  
  
  CONCLUSIONS
  Spontaneous SSDHs without detectable structural lesion or anticoagulant therapy are very rare. Among 26 cases documented the literature harbouring SSDHs, the thoracic spine was found to be the preferred site, and the compression was usually extending over several vertebral levels. Nonoperative treatment for SSDH may be justified in presence of minimal neurologic deficits, otherwise, early decompressive laminectomy along with evacuation of hematoma are considered the treatment of choice in presence of major deficits.
  
  
  CONCLUSIONS
  To our knowledge, the present case is the most extensive laminectomy for a SSDH removal never described before. No postoperative instability occurs in 10 levels thoracic laminectomy in case the articular processes are spared. When major neurological deficits are documented, early decompressive laminectomy with evacuation of hematoma should be considered the best treatment for SSDH.
authors: Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy.
authors: Massimiliano
authors: M
authors: Visocchi
authors: Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy.
authors: Giuseppe
authors: G
authors: La Rocca
authors: Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy. Electronic address: francesco.signorelli1984@gmail.com.
authors: Francesco
authors: F
authors: Signorelli
authors: Institute of Neurosurgery, Catholic University School of Medicine of Rome, Italy.
authors: Romeo
authors: R
authors: Roselli
authors: Department of Neurosurgery, Xin Hua Hospital, Shanghai University, China.
authors: Zhong
authors: Z
authors: Jun
authors: Neurosurgical Unit, Department of Neurosciences, Neurological Centre of Latium, Rome, Italy.
authors: A
authors: A
authors: Spallone