Spontaneous spinal hematoma is a rare yet severe neurological disorder requiring immediate diagnostic evaluation and intervention to prevent enduring neurological deficits. This case series analyzes cases of spontaneous spinal hematoma, especially focusing on cases where vascular causes were identified despite initial inconclusive imaging.
We conducted a retrospective study of 20 consecutive patients treated for spontaneous spinal hematoma at a Level I spine center between 01/01/2017 and 11/15/2023. Data included demographics, clinical presentation, imaging, and treatment details. Traumatic spinal hematomas were excluded. Additionally, we present three cases of spontaneous spinal hematoma attributed to diverse vascular pathologies.
Median age of all patients was 66 (range 39 - 85) years. 9 (45%) were male, 11 (55%) were female. Of 20 cases, 14 were epidural hematomas, 4 subdural, 1 combined epidural and subdural and 1 subarachnoid hemorrhage. 17 patients (85%) presented with a neurological deficit, while 3 patients experienced symptoms solely related to pain. Of the total cohort, 11 (55%) patients were under anticoagulant medication. Vascular anomalies were identified in 5 (25%) cases. In 4 (20%) cases the cause of the spinal hemorrhage remained unclear. MRI was performed for all patients, while DSA was conducted in 5 (25%) cases. 18 patients were treated surgically, while 2 patients were treated conservatively, due to the absence of neurological deficits and spontaneous regression of the epidural hematoma. Postoperatively, 13 (65%) patients showed improvement in their neurological function, 4 (20%) maintained their level, and only 3 (15%) experienced deterioration. The three cases outlined involve individuals with distinct vascular malformations, including two arteriovenous fistulas and one spinal hemangioblastoma, all managed through surgical intervention. Each patient underwent at least one DSA to identify the pathological anomaly.
Spontaneous spinal hematomas demand urgent attention due to their potential for lasting neurological consequences. The study underscores the significance of thorough diagnostics and surgical exploration, especially in cases with unclear etiology, to identify and address vascular causes, preventing hematoma progression or recurrence. Special attention is dedicated to vascular malformations as contributors to spinal hematomas. Although these causes are exceptionally rare, they should consistently be taken into consideration.