Emergency surgery in a patient with large spontaneous spinal epidural hematoma determining excellent neurological recovery: review of the literature

Study design: Case report. Objectives: We report a case of a 75-year-old woman suffering from voluminous idiopathic spontaneous spinal epidural hematoma (SSEH) that was rapidly diagnosed and successfully treated. Methods: Clinical presentation was characterized by sudden and intense back pain that rapidly evolved into plegia of the right leg and severe paresis of the left leg. Hypoesthesia below T6 and urinary retention were also present. Magnetic resonance imaging showed a significant posterior spinal compression from T6 through L3 caused by an epidural hematoma that involved 10 metameric levels, extending for ∼20 cm, with a maximum thickness of 1.6 cm from T12 to L1. Results: Within 12 h, emergency decompressive laminectomy from T10 to L1 was performed, and evacuation of the hematoma was achieved. The postoperative course and neurological recovery of the patient were optimal. After discharge, the patient continued the rehabilitative treatment started during hospitalization, achieving an excellent functional outcome in 1 month. Conclusions: Spinal epidural hematoma (SEH) is a rare clinical finding that can occur following trauma or spontaneously (SSEH). We describe, to the best of our knowledge, the second most extensive idiopathic SSEH and the longest with involvement of the dorso-lumbar spine that had a excellent functional outcome due to emergency decompressive laminectomy, which is emphasized in the treatment of these rare pathologies.