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Abstract

Spinal epidural hematoma is a rare clinical entity with an incidence of approximately one per 1,000,000 patients per year. Spinal epidural hematoma is a lesion that can cause spinal cord compression or cauda equina syndrome. We report a clinical case of а 69-year-old male patient who presented to the Neurosurgery Clinic of the General Hospital for Active Treatment “Dobrich” with pain and weakness in both legs for two months after falling in the bathroom. MRI revealed an L2-L3 fracture and a formation in the L2-L3 epidural space, which was compressing the nerve roots. An operative treatment was performed under general anesthesia and, intraoperatively, it was discovered that the formation was a hematoma. Aspiration of the hematoma and decompression of the spinal canal were performed. An L2-L3 stabilization with pedicle screws was done due to total laminectomy and potential instability. Postoperatively, the patient was mobilized on the day after intervention, and no surgery-related complications were observed. The patient experienced relief from his symptoms and was discharged on the fifth day. Six months post-surgery, the patient started to experience pain in his left leg. Radiography showed coxarthrosis on the left hip joint and the patient was referred to the orthopedics for further treatment.

Introduction

Spinal epidural hematoma is an uncommon acute disorder that can develop on its own or as a result of trauma. About one out of every one million patients experiences a spinal epidural hematoma each year [1]. It is a lesion that may result in the compression of the spinal cord and/or cauda equina [2]. Due to their enhanced bulk, chronic spinal epidural hematomas, however, can pass for spinal tumors [2,3]. The possible risk factors include anticoagulants, disc herniation, hypertension, uremia, chronic kidney disease, dengue fever, coagulopathy, and coronavirus disease 2019 (COVID-19) [4]. MRI can provide the basis for the diagnosis with its particular morphological features and severity. In this study, we emphasize that chronic spinal hematoma should be considered in the differential diagnosis of similar scenarios and for surgical planning. Differential diagnosis of lesions in the lumbar spine can be challenging since prompt management is critical for optimal outcomes. The diagnosis of hematoma is of paramount importance, especially in cases with neurological deterioration. Spinal epidural hematoma is a rare condition, and this case highlights its occurrence post-trauma, emphasizing its uncommon nature as it can mimic other spinal conditions such as tumors. We lay stress on the importance of detailed imaging and differential diagnosis. We undertake a comprehensive case study, addressing the diagnostic, therapeutic, and follow-up aspects of spinal epidural hematoma, and offer insights into its management.

This article was previously presented as a meeting abstract at the XIV National Conference of Rare Diseases and Orphan Drugs in Plovdiv, Bulgaria, on September 29, 2023.

Case Presentation

We discuss a clinical case of a 69-year-old male patient who presented to the Neurosurgery Clinic of the General Hospital for Active Treatment “Dobrich” with complaints of pain and weakness in both legs for two months after falling in the bathroom. MRI revealed an L2-L3 fracture and a formation in the L2-L3 epidural space that was compressing the nerve structures (Figure 1). We analyzed the STIR images, but they showed only the tumor lesion, with no...(More)

For more info please read, Аn Unusual Case of an Epidural Lesion of the Lumbar Spine, by Cureus