title: Spontaneous spinal epidural hematoma management: a case series and literature review.
abstract: OBJECTIVE
  Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Sub-optimal therapeutic principles contribute to SSEH's 5.7% mortality-which patient will benefit from surgery remains unclear. This study aims to investigate parameters that affect SSEH's progression, outlining a best-practice therapeutic approach.
  
  
  METHODS
  Literature review yielded 65 cases from 12 studies. Furthermore, 6 cases were presented from our institution. All data were analyzed under American Spinal Injury Association (ASIA) score guidelines.
  
  
  RESULTS
  Fifty percent of SSEH patients do not fully recover. In all, 30% of patients who presented with an ASIA score of A did not improve with surgery, although every SSEH patient who presented at C or D improved. Spontaneous recovery is rare-only 23% of patients were treated conservatively. Seventy-three percent of those made a full recovery, as opposed to the 48% improvement in patients managed surgically. Thirty-three percent of patients managed conservatively had an initial score of A or B, all improving to a score of D or E without surgery. Regardless, conservative management tends toward low-risk presentations. Patients managed conservatively were three times as likely to have an initial score of D than their surgically managed counterparts.
  
  
  CONCLUSIONS
  The degree of pre-operative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.
authors.affiliation: Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada.
authors.forename: Kyle
authors.initials: K
authors.lastname: Raasck
authors.affiliation: Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Habis
authors.affiliation: Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aoude
authors.affiliation: Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Simões
authors.affiliation: Instituto de Ortopedia e Traumatologia, Oeste D'Or Hospital , Campo Grande, Rio de Janeiro, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Barros
authors.affiliation: Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada.
authors.forename: Rudy
authors.initials: R
authors.lastname: Reindl
authors.affiliation: Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Jarzem
keywords: Neurological disorders; Neurological manifestations; Neurosurgery; Outcomes research; Prognosis