Spontaneous spinal epidural hemorrhage: A case series and literature review

Background Spontaneous spinal epidural hemorrhage (SSEH) is a rare but serious condition that can rapidly lead to significant neurological deficits. The aims of this study were to report our case series, analyze the clinical features of SSEH, and explore its early diagnosis and treatment. Methods We retrospectively analyzed 13 patients with SSEH who were treated at our institution from January 2017 to December 2023. Demographic data, medical histories, presenting symptoms, pre/post-treatment neurologic status, imaging findings, treatment and patient outcomes were collected and analyzed. Neurologic status was assessed using the American Spinal Injury Association (ASIA) motor score (AMS) and the ASIA Impairment Scale (AIS). Results This cohort, including seven men and six women. The hematoma segments were located from C2 to L5, with the majority occupied at the cervical segment. Seven patients received surgical intervention and six patients receive conservative treatment. Compared with conservatively treated patients, surgically treated patients had lower admission ASIA motor score (48.4 vs 90). At last follow-up, all six conservative patients had fully recovered. Among the surgical patients, two achieved complete recovery, three showed significant improvement (AIS D), and two had minor or no recovery (AIS A). Conclusion Early recognition and timely intervention are essential for improving the prognosis of patients with SSEH. In patients with suspected SSEH, prompt spinal MRI should be performed. Conservative treatment may be considered for patients with mild or slowly progressive neurological deficits, while surgical intervention should be pursued for patients with severe and rapidly advancing neurological symptoms.