目的:自发性脊髓硬膜外血肿(SSEH)是一种罕见但严重的疾病,占不到1%的脊柱病变,每年的发病率为0.1/100,000。1869年由杰克逊发现,大约40-50%的SSEH病例往往缺乏明确的病因,尽管有风险因素,如抗凝血剂的使用,血管畸形,和高血压是公认的。症状从轻度疼痛到严重的神经损伤,如轻瘫,取决于脊髓压迫程度。及时治疗,通常涉及脊柱减压和血肿清除,是至关重要的,尤其是在神经系统衰退的情况下。该研究旨在通过对患者病例的检查,对SSEH进行全面分析,关键预后因素,和治疗策略,根据人口统计,临床资料,以及在三军总医院观察到的结果。
方法:本回顾性研究,2003-2023年在三军总医院,分析了14例SSEH患者。它检查了人口统计,危险因素,临床和放射学概况,治疗,结果,和预测,使用SPSS软件(22.0版)并遵循改良Rankin量表(mRS)和美国脊髓损伤协会(ASIA)损伤量表指南进行数据分析。
结果:在14例SSEH患者的研究中,93%接受了紧急手术,包括全椎板切除术或开式椎板成形术,7%接受保守治疗。手术后,69.2%的人在一年的随访中表现出良好的结果(mRS≤2),而30.8%的结果较差(mRS3-4)。初始ASIA评分和一年mRS结果之间存在显著负相关,表明初始减值较少,预示着更好的复苏。这些结果表明,治疗延迟与一年mRS评分之间存在中度正相关。然而,因素,比如年龄,抗血小板使用,脊髓水平与血肿定位,治疗前观察到的脊髓病体征在1年随访期间未显示对神经系统结局有显著影响.
结论:初始缺陷较小或接受早期手术的患者,最好在症状发作的12-36小时内,表现出更好的神经恢复。不良预后与抗凝剂的高国际标准化比率(INR)相关,血肿大小,腰椎受累,或严重的电机问题。建议快速手术清除血肿。我们的研究支持在所有情况下手术干预后神经功能的恢复,强调即使在严重和长时间的SSEH病例中,手术减压的潜在疗效。
OBJECTIVE: Spontaneous spinal epidural hematoma (SSEH) is a rare but serious condition, accounting for less than 1% of spinal lesions, with an incidence of 0.1 per 100,000 annually. Discovered by Jackson in 1869, around 40-50% of SSEH cases often lack a definitive cause, though risk factors, such as anticoagulant usage, vascular malformations, and hypertension are recognized. Symptoms vary from mild pain to severe neurological impairments like paraparesis, depending on the spinal cord compression level. Prompt treatment, usually involving spinal decompression and hematoma removal, is crucial, especially in cases of neurological decline. The study aims to provide comprehensive analysis of SSEH through examination of by patient cases, critical prognostic factors, and therapeutic strategies, based on demographics, clinical data, and outcomes observed at the Tri-Service General Hospital.
METHODS: This retrospective study, spanning 2003-2023 at the Tri-Service General Hospital, analyzed 14 patients with SSEH. It examined demographics, risk factors, clinical and radiological profiles, treatments, outcomes, and prognoses, using SPSS software (version 22.0) and adhering to the Modified Rankin Scale (mRS) and the American Spinal Injury Association (ASIA) impairment scale guidelines for data analysis.
RESULTS: In this study of 14 patients with SSEH, 93% underwent urgent surgery, including total laminectomy or open-door laminoplasty, while 7% received conservative treatment. Post-surgery, 69.2% showed favorable outcomes (mRS ≤2) in the one-year follow-up, while 30.8% had poorer results (mRS 3-4). A significant negative correlation was noted between initial ASIA scores and one-year mRS outcomes, suggesting less initial impairment predicts better recovery. These findings indicated that a moderate positive correlation between treatment delay and one-year mRS scores. Nevertheless, factors, such as age, antiplatelet use, spinal levels with hematoma localization, and myelopathy signs observed before treatment did not demonstrate any significant effects on neurological outcomes during the one-year follow-up.
CONCLUSIONS: Patients with minor initial deficits or those receiving early surgery, preferably within 12-36 h of symptom onset, exhibit better neurological recovery. Poor prognosis correlates with high International Normalized Ratio (INR) on anticoagulants, hematoma size, lumbar involvement, or severe motor issues. Rapid surgical hematoma evacuation is advised. Our study supports recovery of neurological function following surgical intervention in all cases, highlighting the potential efficacy of surgical decompression even in severe and prolonged instances of SSEH.