Skip to main content

Advertisement

SpringerLink
Log in

Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Jackson R (1869) Case of spinal apoplexy. Lancet 94:5–6. https://doi.org/10.1016/s0140-6736(02)67624-x

    Article  Google Scholar 

  2. Groen RJM, Ponssen H (1990) The spontaneous spinal epidural hematoma A study of the etiology. J Neurol Sci 98:121–138. https://doi.org/10.1016/0022-510x(90)90253-j

    Article  CAS  PubMed  Google Scholar 

  3. Groen RJM (2004) Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir 146:103–110. https://doi.org/10.1007/s00701-003-0160-9

    Article  CAS  PubMed  Google Scholar 

  4. Dziedzic T, Kunert P, Krych P, Marchel A (2015) Management and neurological outcome of spontaneous spinal epidural hematoma. J Clin Neurosci 22:726–729. https://doi.org/10.1016/j.jocn.2014.11.010

    Article  PubMed  Google Scholar 

  5. Matsumura A, Namikawa T, Hashimoto R, Okamoto T, Yanagida I, Hoshi M, Noguchi K, Takami M (2008) Clinical management for spontaneous spinal epidural hematoma: diagnosis and treatment. Spine J 8:534–537. https://doi.org/10.1016/j.spinee.2007.01.009

    Article  PubMed  Google Scholar 

  6. Groen RJM, van Alphen HAM (1996) Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery 39:494–508. https://doi.org/10.1097/00006123-199609000-00012

    Article  CAS  PubMed  Google Scholar 

  7. Shin J-J, Kuh S-U, Cho Y-E (2006) Surgical management of spontaneous spinal epidural hematoma. Eur Spine J 15:998–1004. https://doi.org/10.1007/s00586-005-0965-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Liao C-C, Hsieh P-C, Lin T-K et al (2009) Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience: Clinical article. J Neurosurg Spine 11:480–486. https://doi.org/10.3171/2009.4.spine08904

    Article  PubMed  Google Scholar 

  9. Liao C-C, Lee S-T, Hsu W-C, Chen LR, Lui TN, Lee SC (2004) Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg 100:38–45

    PubMed  Google Scholar 

  10. Rajz G, Cohen JE, Harnof S, Knoller N, Goren O, Shoshan Y, Fraifeld S, Kaplan L, Itshayek E (2015) Spontaneous spinal epidural hematoma: the importance of preoperative neurological status and rapid intervention. J Clin Neurosci 22:123–128. https://doi.org/10.1016/j.jocn.2014.07.003

    Article  PubMed  Google Scholar 

  11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. https://doi.org/10.1016/s0140-6736(07)61602-x

    Article  Google Scholar 

  12. Roberts TT, Leonard GR, Cepela DJ (2017) Classifications in brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res 475:1499–1504. https://doi.org/10.1007/s11999-016-5133-4

    Article  PubMed  Google Scholar 

  13. Moriarty HK, Cearbhaill RO, Moriarty PD, Stanley E, Lawler LP, Kavanagh EC (2019) MR imaging of spinal haematoma: a pictorial review. Br J Radiology 92:20180532. https://doi.org/10.1259/bjr.20180532

    Article  Google Scholar 

  14. Marhold F, Popadic B, Rechberger P, Berger-Brabec S, Decristoforo I, Sherif C, Scheichel F (2021) Extent of spinal canal obliteration as prognostic factor for functional outcome in patients with spontaneous spinal epidural hematoma: a retrospective study. Acta Neurochir 163:3279–3286. https://doi.org/10.1007/s00701-021-05011-x

    Article  PubMed  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  Google Scholar 

  16. Holtås S, Heiling M, Lönntoft M (1996) Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation. Radiology 199:409–413. https://doi.org/10.1148/radiology.199.2.8668786

    Article  PubMed  Google Scholar 

  17. Kreppel D, Antoniadis G, Seeling W (2003) Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 26:1–49. https://doi.org/10.1007/s10143-002-0224-y

    Article  CAS  PubMed  Google Scholar 

  18. Tamburrelli FC, Meluzio MC, Masci G, Perna A, Burrofato A, Proietti L (2018) Etiopathogenesis of traumatic spinal epidural hematoma. Neurospine 15:101–107. https://doi.org/10.14245/ns.1834938.469

    Article  PubMed  PubMed Central  Google Scholar 

  19. Nagata K, Oshima Y, Nakajima K, Higashikawa A, Ando T, Kobayashi A, Taniguchi Y, Matsubayashi Y (2019) Consecutive images of conservatively treated cervical spontaneous spinal epidural hematoma. J Clin Neurosci 59:270–275. https://doi.org/10.1016/j.jocn.2018.10.097

    Article  PubMed  Google Scholar 

  20. Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD (2007) Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults1. Radiographics 27:173–187. https://doi.org/10.1148/rg.271065065

    Article  PubMed  Google Scholar 

  21. Hentschel SJ, Woolfenden AR, Fairholm DJ (2001) Resolution of spontaneous spinal epidural hematoma without surgery. Spine 26:E525–E527. https://doi.org/10.1097/00007632-200111150-00025

    Article  CAS  PubMed  Google Scholar 

  22. Eming SA, Wynn TA, Martin P (2017) Inflammation and metabolism in tissue repair and regeneration. Science 356:1026–1030. https://doi.org/10.1126/science.aam7928

    Article  CAS  PubMed  Google Scholar 

  23. Smigiel KS, Parks WC (2018) Macrophages, wound healing, and fibrosis: recent insights. Curr Rheumatol Rep 20:17. https://doi.org/10.1007/s11926-018-0725-5

    Article  CAS  PubMed  Google Scholar 

  24. Bradley WG (1993) MR appearance of hemorrhage in the brain. Radiology 189:15–26. https://doi.org/10.1148/radiology.189.1.8372185

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan

    Shintaro Honda, Shunsuke Fujibayashi, Takayoshi Shimizu, Koichi Murata, Bungo Otsuki & Shuichi Matsuda

  2. Department of Orthopedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Naoya Tsubouchi

  3. Department of Orthopedic Surgery, Japan Community Health Care Organization Tamatsukuri Hospital, Shimane, Japan

    Yusuke Kanba

  4. Department of Orthopedic Surgery, Fukui Red Cross Hospital, Fukui, Japan

    Takashi Sono

  5. Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan

    Hiroaki Kimura

  6. Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan

    Seichi Odate

  7. Department of Orthopedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

    Eijiro Onishi

  8. Department of Orthopedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan

    Yasuyuki Tamaki

  9. Department of Orthopedic Surgery, Tenri Hospital, Nara, Japan

    Takuya Tomizawa

  10. Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan

    Ryosuke Tsutsumi

  11. Department of Orthopaedic Surgery, Otsu Red Cross Hospital, Shiga, Japan

    Ko Yasura

Authors
  1. Shintaro Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shunsuke Fujibayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takayoshi Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoya Tsubouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yusuke Kanba
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Sono
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroaki Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seichi Odate
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eijiro Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasuyuki Tamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takuya Tomizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ryosuke Tsutsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ko Yasura
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Koichi Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Bungo Otsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Shuichi Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Shintaro Honda, Takayoshi Shimizu, and Shunsuke Fujibayashi contributed to the study’s conception and design. Material preparation and data collection were performed by Shintaro Honda, Naoya Tsubouchi, Yusuke Kanba, Takashi Sono, Hiroaki Kimura, Seichi Odate, Eijiro Onishi, Yasuyuki Tamaki, Takuya Tomizawa, Ryosuke Tsutsumi, and Ko Yasura. The first draft of the manuscript was written by Shintaro Honda and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Corresponding author

Correspondence to Shintaro Honda.

Ethics declarations

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the institutional ethics committee of Kyoto University (IRB number R2901, March 18, 2021), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate and for publication

Written informed consent to participate in this study was waived due to the retrospective observational nature of this study, and no identifiable information of the participants was included in the manuscript. Patients signed informed consent regarding publishing their data and photographs.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Honda, S., Fujibayashi, S., Shimizu, T. et al. Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas. International Orthopaedics (SICOT) 46, 2347–2355 (2022). https://doi.org/10.1007/s00264-022-05513-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05513-y

Keywords

Search

Navigation