title: Spinal Epidural Hematoma Related to Vertebral Fracture in an Atypical Rigid Diffuse Idiopathic Skeletal Hyperostosis: A Case Report.
abstract: BACKGROUND
  Spinal epidural hematoma (SEH) is a rare disease that causes cord compression and neurologic deficit. Spontaneous SEH is related to minor trauma, bleeding disorders, and anticoagulant medications. Posttraumatic SEH has been associated with low-energy spine hyperextension injuries in patients with ankylosing spinal disorders such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH). A variant named atypical DISH-like with SEH is reported.
  
  
  OBJECTIVE
  To describe the management, diagnosis, and treatment of an unusual SEH case in a patient causing delayed neurologic deficit with rigid atypical DISH-like spine.
  
  
  METHODS
  An elderly woman with prior antiplatelet therapy presented with delayed neurological deficit suffering trauma after falling. Computed tomography (CT) imaging studies reveal hyperextension fracture pattern and signs mimic DISH missed on standard X-ray images. Magnetic resonance (MR) study demonstrates posterior epidural mass compatible with SEH in thoracic spine with cord compression. Using a midline posterior approach, an urgent intervention and a left multiple partial unilateral decompressive laminectomy at T4-T7 and a long instrumented fusion at T3-T9 were performed for achieving spinal stability and neurological improvement, both of which were observed.
  
  
  CONCLUSIONS
  Patients with rigid spine who sustain low-energy injuries may be prone to have a fracture and epidural hematoma, especially if they take anticoagulant medications. Imaging studies including MR and CT scans should be reviewed carefully to rule out any occult fracture. Urgent or early surgical hematoma drainage and instrumented fusion must be performed to achieve stability and functional recovery.
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Ramírez Villaescusa
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: Restrepo Pérez
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Ruiz Picazo
keywords: geriatric trauma; neurological impairment; rigid spine; spinal epidural hematoma; spine surgery; vertebral fracture