Outcomes of Conservative Management of Spontaneous Spinal Epidural Hematomas: A Retrospective Study

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BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare condition. The clinical characteristics and disease course of patients with SSEH treated conservatively for SSEH remain unclear. Therefore, this study aimed to clarify the clinical characteristics and courses of conservatively treated SSEH. METHODS: We retrospectively reviewed and analyzed patients with conservatively treated SSEH admitted to the Shinshu University Hospital between July 2009 and December 2023. RESULTS: We identified 22 patients with conservatively treated SSEH (9 men and 13 women) aged 40-85 years (median age, 69 years). A total of 13 patients had an American Spinal Injury Association (ASIA) score of E at admission. Seven patients were on antiplatelet therapy, and one was taking anticoagulants. The interval between the first and second magnetic resonance imaging (MRI) scans was five days (4-6.75 days). The size of hematomas decreased on the second MRI in all cases but did not regress. Patients were allowed to mobilize from bed after six days (5-7 days), with the length of hospital stay being 10.5 days (9-13 days), and no cases of recurrence were reported. CONCLUSIONS: MRI re-evaluation approximately five days after the first assessment facilitated early rehabilitation in patients with conservatively treated SSEH. Consequently, conservative management should include neurological assessments and follow-up MRIs during hospitalization.

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