Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas
Purpose This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI). Methods We included 57 patients treated for acute SSEH at 11 institutions and retrospectively anal...
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Veröffentlicht in: | International orthopaedics 2022-10, Vol.46 (10), p.2347-2355 |
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creator | Honda, Shintaro Fujibayashi, Shunsuke Shimizu, Takayoshi Tsubouchi, Naoya Kanba, Yusuke Sono, Takashi Kimura, Hiroaki Odate, Seichi Onishi, Eijiro Tamaki, Yasuyuki Tomizawa, Takuya Tsutsumi, Ryosuke Yasura, Ko Murata, Koichi Otsuki, Bungo Matsuda, Shuichi |
description | Purpose
This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI).
Methods
We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission.
Results
Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition.
Conclusions
In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention. |
doi_str_mv | 10.1007/s00264-022-05513-y |
format | Article |
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This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI).
Methods
We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission.
Results
Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition.
Conclusions
In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention.</description><identifier>ISSN: 0341-2695</identifier><identifier>EISSN: 1432-5195</identifier><identifier>DOI: 10.1007/s00264-022-05513-y</identifier><identifier>PMID: 35854055</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Cervical Vertebrae ; Hematoma, Epidural, Spinal - diagnostic imaging ; Hematoma, Epidural, Spinal - etiology ; Humans ; Magnetic Resonance Imaging ; Medicine ; Medicine & Public Health ; Original Paper ; Orthopedics ; Paralysis - diagnostic imaging ; Paralysis - etiology ; Retrospective Studies</subject><ispartof>International orthopaedics, 2022-10, Vol.46 (10), p.2347-2355</ispartof><rights>The Author(s) under exclusive licence to SICOT aisbl 2022</rights><rights>2022. The Author(s) under exclusive licence to SICOT aisbl.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-ffbfe293b8277072ec60dd09bf1fa87d370f70202dfaf631b7e9244655fe24133</citedby><cites>FETCH-LOGICAL-c347t-ffbfe293b8277072ec60dd09bf1fa87d370f70202dfaf631b7e9244655fe24133</cites><orcidid>0000-0001-9387-7730</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00264-022-05513-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00264-022-05513-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35854055$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Honda, Shintaro</creatorcontrib><creatorcontrib>Fujibayashi, Shunsuke</creatorcontrib><creatorcontrib>Shimizu, Takayoshi</creatorcontrib><creatorcontrib>Tsubouchi, Naoya</creatorcontrib><creatorcontrib>Kanba, Yusuke</creatorcontrib><creatorcontrib>Sono, Takashi</creatorcontrib><creatorcontrib>Kimura, Hiroaki</creatorcontrib><creatorcontrib>Odate, Seichi</creatorcontrib><creatorcontrib>Onishi, Eijiro</creatorcontrib><creatorcontrib>Tamaki, Yasuyuki</creatorcontrib><creatorcontrib>Tomizawa, Takuya</creatorcontrib><creatorcontrib>Tsutsumi, Ryosuke</creatorcontrib><creatorcontrib>Yasura, Ko</creatorcontrib><creatorcontrib>Murata, Koichi</creatorcontrib><creatorcontrib>Otsuki, Bungo</creatorcontrib><creatorcontrib>Matsuda, Shuichi</creatorcontrib><title>Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas</title><title>International orthopaedics</title><addtitle>International Orthopaedics (SICOT)</addtitle><addtitle>Int Orthop</addtitle><description>Purpose
This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI).
Methods
We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission.
Results
Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition.
Conclusions
In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention.</description><subject>Cervical Vertebrae</subject><subject>Hematoma, Epidural, Spinal - diagnostic imaging</subject><subject>Hematoma, Epidural, Spinal - etiology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Paper</subject><subject>Orthopedics</subject><subject>Paralysis - diagnostic imaging</subject><subject>Paralysis - etiology</subject><subject>Retrospective Studies</subject><issn>0341-2695</issn><issn>1432-5195</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFP5CAYholxo-Osf8CD6dFL9QNKaY_G6K6JcS-7Z0Lbj5FJCyMUk_n3y1j16IkvfO_7BB5CLihcUwB5EwFYXZXAWAlCUF7uj8iKVpyVgrbimKyAV7RkdStOyVmMWwAq64aekFMuGlHlzoq8PmMKfvQb2-uxiPiGwc77At_0mPRsvStStG5TTHrjcLZ9ETB6p12Phc13h5V1he7TjEXceTdrhz7FPFuXgbizQwp5eNE46dlPOv4kP4weI55_nGvy7-H-793v8unPr8e726ey55WcS2M6g6zlXcOkBMmwr2EYoO0MNbqRA5dgJDBgg9Gm5rST2LKqqoXItYpyviZXC3cX_GvCOKvJxh7HcXmhyl5Y5vKG5Shbon3wMQY0ahfy78JeUVAH1WpRrbJq9a5a7XPp8oOfugmHr8qn2xzgSyDmldtgUFufQrYSv8P-Bx32jRg</recordid><startdate>20221001</startdate><enddate>20221001</enddate><creator>Honda, Shintaro</creator><creator>Fujibayashi, Shunsuke</creator><creator>Shimizu, Takayoshi</creator><creator>Tsubouchi, Naoya</creator><creator>Kanba, Yusuke</creator><creator>Sono, Takashi</creator><creator>Kimura, Hiroaki</creator><creator>Odate, Seichi</creator><creator>Onishi, Eijiro</creator><creator>Tamaki, Yasuyuki</creator><creator>Tomizawa, Takuya</creator><creator>Tsutsumi, Ryosuke</creator><creator>Yasura, Ko</creator><creator>Murata, Koichi</creator><creator>Otsuki, Bungo</creator><creator>Matsuda, Shuichi</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9387-7730</orcidid></search><sort><creationdate>20221001</creationdate><title>Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas</title><author>Honda, Shintaro ; Fujibayashi, Shunsuke ; Shimizu, Takayoshi ; Tsubouchi, Naoya ; Kanba, Yusuke ; Sono, Takashi ; Kimura, Hiroaki ; Odate, Seichi ; Onishi, Eijiro ; Tamaki, Yasuyuki ; Tomizawa, Takuya ; Tsutsumi, Ryosuke ; Yasura, Ko ; Murata, Koichi ; Otsuki, Bungo ; Matsuda, Shuichi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-ffbfe293b8277072ec60dd09bf1fa87d370f70202dfaf631b7e9244655fe24133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cervical Vertebrae</topic><topic>Hematoma, Epidural, Spinal - diagnostic imaging</topic><topic>Hematoma, Epidural, Spinal - etiology</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Paper</topic><topic>Orthopedics</topic><topic>Paralysis - diagnostic imaging</topic><topic>Paralysis - etiology</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Honda, Shintaro</creatorcontrib><creatorcontrib>Fujibayashi, Shunsuke</creatorcontrib><creatorcontrib>Shimizu, Takayoshi</creatorcontrib><creatorcontrib>Tsubouchi, Naoya</creatorcontrib><creatorcontrib>Kanba, Yusuke</creatorcontrib><creatorcontrib>Sono, Takashi</creatorcontrib><creatorcontrib>Kimura, Hiroaki</creatorcontrib><creatorcontrib>Odate, Seichi</creatorcontrib><creatorcontrib>Onishi, Eijiro</creatorcontrib><creatorcontrib>Tamaki, Yasuyuki</creatorcontrib><creatorcontrib>Tomizawa, Takuya</creatorcontrib><creatorcontrib>Tsutsumi, Ryosuke</creatorcontrib><creatorcontrib>Yasura, Ko</creatorcontrib><creatorcontrib>Murata, Koichi</creatorcontrib><creatorcontrib>Otsuki, Bungo</creatorcontrib><creatorcontrib>Matsuda, Shuichi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Honda, Shintaro</au><au>Fujibayashi, Shunsuke</au><au>Shimizu, Takayoshi</au><au>Tsubouchi, Naoya</au><au>Kanba, Yusuke</au><au>Sono, Takashi</au><au>Kimura, Hiroaki</au><au>Odate, Seichi</au><au>Onishi, Eijiro</au><au>Tamaki, Yasuyuki</au><au>Tomizawa, Takuya</au><au>Tsutsumi, Ryosuke</au><au>Yasura, Ko</au><au>Murata, Koichi</au><au>Otsuki, Bungo</au><au>Matsuda, Shuichi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas</atitle><jtitle>International orthopaedics</jtitle><stitle>International Orthopaedics (SICOT)</stitle><addtitle>Int Orthop</addtitle><date>2022-10-01</date><risdate>2022</risdate><volume>46</volume><issue>10</issue><spage>2347</spage><epage>2355</epage><pages>2347-2355</pages><issn>0341-2695</issn><eissn>1432-5195</eissn><abstract>Purpose
This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI).
Methods
We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission.
Results
Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition.
Conclusions
In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35854055</pmid><doi>10.1007/s00264-022-05513-y</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9387-7730</orcidid></addata></record> |
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subjects | Cervical Vertebrae Hematoma, Epidural, Spinal - diagnostic imaging Hematoma, Epidural, Spinal - etiology Humans Magnetic Resonance Imaging Medicine Medicine & Public Health Original Paper Orthopedics Paralysis - diagnostic imaging Paralysis - etiology Retrospective Studies |
title | Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas |
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