title: Clinical Features, Management, and Prognostic Factors of Spontaneous Epidural Spinal Hematoma: Analysis of 24 Cases.
abstract: BACKGROUND
  Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical emergency. It presents as acute spinal cord compression and usually requires surgical decompression. The patients who will benefit most from decompression surgery are unknown, and the factors associated with prognosis remain controversial. The purpose of our study was to identify the clinical features, treatments, and main factors related to the prognosis of SSEH.
  
  
  METHODS
  We reviewed the records of 24 patients treated for SSEH from September 2010 to January 2016 at West China Hospital. Clinical features, radiologic images, treatment methods, and clinical outcomes were reviewed retrospectively. To ascertain which factors were related to outcomes, statistical analysis was performed.
  
  
  RESULTS
  Among 24 patients, 19 presented with severe initial neurologic deficits (American Spinal Injury Association grade A-C) underwent decompressive surgery, and the remaining patients (initial American Spinal Injury Association grade D or E) received conservative treatment. Among the 19 patients in the operation group, seven (36.8%) had good outcomes, whereas 12 (63.2%) had poor outcomes. All patients in the conservative group had good outcomes.
  
  
  CONCLUSIONS
  SSEH is a rare but serious illness. It is more likely that SSEH arises from a ruptured internal vertebral venous plexus. The initial neurologic status is the determining factor influencing the treatment method and clinical outcome. The number of involved segments cannot be used to decide the treatment method or predict prognosis. Patients with shorter operative intervals appear to have better neurologic recovery.
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Peizhi
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China. Electronic address: jiangshuhx123@126.com.
authors.forename: Shu
authors.initials: S
authors.lastname: Jiang
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: Internal vertebral venous plexus; Prognostic factor; Spontaneous epidural spinal hematoma; Treatment