Finding
The study investigated the indications and timing for conservative and surgical treatment in acute spinal epidural hematoma, and found that chances for complete recovery from severe paralysis were significantly higher in patients who underwent surgery within 24 hours, while signs of recovery should be observed for up to 15 hours from the onset of paralysis before switching to surgical treatment.
Paper
Indications and Timing for Conservative Treatment and Surgical Treatment in Acute Spinal Epidural Hematoma
Observational Study
Citations: 1
Full text
Semantic ScholarAbstract
Acute, progressive paralysis or bladder and bowel disturbance may occur with acute spinal epidural hematoma, but in some cases, the symptom spontaneously resolve. In this study, the clinical characteristics of acute spinal epidural hematoma were clarified, and the indications for and timing of surgery were investigated. Among the reported cases in Japan over a period of about 30 years until 2013, cases without paralysis or trauma, those with no epidural block or catheterization, and those involving the lumbar spine were excluded, and then, 11 factors that contributed to treatment outcomes were identified. One hundred twenty‒one cases(8 of our own)were then carefully selected, including 62 treated conservatively(non‒operative treatment)and 59 treated surgically. Univariate and multiple logistic regression analyses were conducted. Among the conservative treatment cases, (1) no anticoagulant therapy, (2)paralysis severity of C or D in Frankel classification, (3)and time of the start of recovery(within 15 hours)were the factors associated with spontaneous recovery. Chances for complete recovery from severe paralysis of severity A or B were significantly higher in patients who underwent surgery within 24 hours. We consider the period is the appropriate decision‒making time to switch to surgical treatment. In this disease, signs of recovery should be observed for up to 15 hours from the onset of paralysis. If the possibility of non‒surgical complete recovery is low, then a switch to surgery should be made within 24 hours. (Received:November 29, 2014;accepted:October 1, 2015)
Authors
Y. Musha, Keisuke Ito, T. Sunakawa
Journal
Spinal Surgery