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Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma.
Eur Spine J. 2004 Jul; 13(4):380-3.ES

Abstract

Spontaneous spinal subdural haematoma is a rare cause of spinal cord compression, usually confined to a few vertebral levels. When the haematoma extends over several spinal segments, surgical decompression is a major undertaking. Recombinant tissue plasminogen activator (rt-PA) has previously been used in a number of surgical procedures, but not in the setting of acute spinal subdural haematoma. A minimally invasive technique of decompression, using topical rt-PA, is presented in two patients with extensive spinal intradural haematoma. Two patients receiving long-term anticoagulation therapy presented with acute-onset back pain progressing to paraparesis. Magnetic resonance imaging of the spine demonstrated spinal subdural haematomas extending over 15 vertebral levels in one patient and 12 in the other. An angiography catheter was introduced into the subdural space through a limited laminectomy. Thrombolysis and evacuation of haematoma was then achieved by intermittent irrigation of the subdural space with rt-PA, followed by saline lavage. Postoperative imaging demonstrated satisfactory decompression in both patients. There was significant improvement of neurological function in one patient. Topical application of rt-PA for spinal subdural haematoma allows evacuation of the haematoma through a limited surgical exposure. Decompression of the subdural space by this minimally invasive technique may be advantageous over extensive surgery by minimising surgical exposure, reducing postoperative pain and risk of neuronal injury. This technique may be useful in patients presenting with compression extending over several vertebral levels or poor surgical candidates.

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Authors+Show Affiliations

Little CP
Department of Neurological Surgery, Frenchay Hospital, Bristol, UK.
Patel N
No affiliation info available
Nagaria J
No affiliation info available
Kumar R
No affiliation info available
Nanra J
No affiliation info available
Bolger CM
No affiliation info available

MeSH

Acute DiseaseAgedCombined Modality TherapyFemaleFibrinolytic AgentsHematoma, Subdural, SpinalHumansLaminectomyMagnetic Resonance ImagingRecombinant ProteinsTherapeutic IrrigationTissue Plasminogen Activator

Pub Type(s)

Case Reports
Journal Article
Technical Report

Language

eng

PubMed ID

12920622

Citation

Little, C P., et al. "Use of Topically Applied rt-PA in the Evacuation of Extensive Acute Spinal Subdural Haematoma." European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 13, no. 4, 2004, pp. 380-3.
Little CP, Patel N, Nagaria J, et al. Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma. Eur Spine J. 2004;13(4):380-3.
Little, C. P., Patel, N., Nagaria, J., Kumar, R., Nanra, J., & Bolger, C. M. (2004). Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 13(4), 380-3.
Little CP, et al. Use of Topically Applied rt-PA in the Evacuation of Extensive Acute Spinal Subdural Haematoma. Eur Spine J. 2004;13(4):380-3. PubMed PMID: 12920622.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma. AU - Little,C P, AU - Patel,N, AU - Nagaria,J, AU - Kumar,R, AU - Nanra,J, AU - Bolger,C M, Y1 - 2003/08/14/ PY - 2002/02/27/received PY - 2002/12/14/revised PY - 2002/12/21/accepted PY - 2003/8/16/pubmed PY - 2004/12/16/medline PY - 2003/8/16/entrez SP - 380 EP - 3 JF - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JO - Eur Spine J VL - 13 IS - 4 N2 - Spontaneous spinal subdural haematoma is a rare cause of spinal cord compression, usually confined to a few vertebral levels. When the haematoma extends over several spinal segments, surgical decompression is a major undertaking. Recombinant tissue plasminogen activator (rt-PA) has previously been used in a number of surgical procedures, but not in the setting of acute spinal subdural haematoma. A minimally invasive technique of decompression, using topical rt-PA, is presented in two patients with extensive spinal intradural haematoma. Two patients receiving long-term anticoagulation therapy presented with acute-onset back pain progressing to paraparesis. Magnetic resonance imaging of the spine demonstrated spinal subdural haematomas extending over 15 vertebral levels in one patient and 12 in the other. An angiography catheter was introduced into the subdural space through a limited laminectomy. Thrombolysis and evacuation of haematoma was then achieved by intermittent irrigation of the subdural space with rt-PA, followed by saline lavage. Postoperative imaging demonstrated satisfactory decompression in both patients. There was significant improvement of neurological function in one patient. Topical application of rt-PA for spinal subdural haematoma allows evacuation of the haematoma through a limited surgical exposure. Decompression of the subdural space by this minimally invasive technique may be advantageous over extensive surgery by minimising surgical exposure, reducing postoperative pain and risk of neuronal injury. This technique may be useful in patients presenting with compression extending over several vertebral levels or poor surgical candidates. SN - 0940-6719 UR - https://www.unboundmedicine.com/medline/citation/12920622/Use_of_topically_applied_rt_PA_in_the_evacuation_of_extensive_acute_spinal_subdural_haematoma_ DB - PRIME DP - Unbound Medicine ER -