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Surgical treatment of progressive cauda equina compression caused by spontaneous spinal subdural hematoma: A case report.
Medicine (Baltimore). 2019 Mar; 98(12):e14598.M

Abstract

RATIONALE

Spontaneous spinal subdural hematoma (SSDH) without an underlying pathology is a very rare condition. The treatment protocol for SSDH is early diagnosis and treatment before irreversible damage to neural tissue. However, there is no agreement on the etiopathogenesis, as well as the need for surgery to treat spontaneous SSDH. Here, we report a rare case of spontaneous SSDH with progressive deterioration and symptoms of cauda equina syndrome after ineffective conservative treatment.

PATIENT'S CONCERN

A 38-year-old male patient presented with sudden lower back and bilateral leg pain.

DIAGNOSIS

A magnetic resonance imaging (MRI) scan on the third day after the onset of symptoms revealed a subdural hematoma from L1 to S1, presenting as hyperintensities on T1 weighted sequences and hypointensities to isointensities on T2 weighted sequences.

INTERVENTION

Laminectomy and subdural evacuation were performed immediately.

OUTCOMES

An abnormal ligamentum flavum was observed intraoperatively. A histological examination revealed extravasation of blood in the degenerated ligamentum flavum. Postoperatively, the lower limb pain improved immediately. At the 6-month follow-up, the pain and numbness of the lower limb disappeared, and the muscle strength of both legs recovered completely with normal gait.

LESSONS

Spontaneous SSDH with ligamentum flavum hematoma was caused by a sudden increase of intravenous pressure, resulting from a marked surge in the intra-abdominal or intrathoracic pressure. Consecutive MRI scans provided valuable information, leading to a diagnosis of spontaneous SSDH. The treatment protocol for spontaneous SSDH should be determined based on the location and stage of the hematoma, as well as the subject's neurological status.

Links

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Authors+Show Affiliations

Li X
Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou.
Yang G
Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou. Department of Orthopedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Hunan, China.
Wen Z
Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou.
Lou X
Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou.
Lin X
Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou.

MeSH

AdultCauda EquinaHematoma, Subdural, SpinalHumansLaminectomyLigamentum FlavumLumbar VertebraeMagnetic Resonance ImagingMaleSacrum

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30896615

Citation

Li, Xigong, et al. "Surgical Treatment of Progressive Cauda Equina Compression Caused By Spontaneous Spinal Subdural Hematoma: a Case Report." Medicine, vol. 98, no. 12, 2019, pp. e14598.
Li X, Yang G, Wen Z, et al. Surgical treatment of progressive cauda equina compression caused by spontaneous spinal subdural hematoma: A case report. Medicine (Baltimore). 2019;98(12):e14598.
Li, X., Yang, G., Wen, Z., Lou, X., & Lin, X. (2019). Surgical treatment of progressive cauda equina compression caused by spontaneous spinal subdural hematoma: A case report. Medicine, 98(12), e14598. https://doi.org/10.1097/MD.0000000000014598
Li X, et al. Surgical Treatment of Progressive Cauda Equina Compression Caused By Spontaneous Spinal Subdural Hematoma: a Case Report. Medicine (Baltimore). 2019;98(12):e14598. PubMed PMID: 30896615.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of progressive cauda equina compression caused by spontaneous spinal subdural hematoma: A case report. AU - Li,Xigong, AU - Yang,Ge, AU - Wen,Zhiqiang, AU - Lou,Xianfeng, AU - Lin,Xiangjin, PY - 2019/3/22/entrez PY - 2019/3/22/pubmed PY - 2019/4/10/medline SP - e14598 EP - e14598 JF - Medicine JO - Medicine (Baltimore) VL - 98 IS - 12 N2 - RATIONALE: Spontaneous spinal subdural hematoma (SSDH) without an underlying pathology is a very rare condition. The treatment protocol for SSDH is early diagnosis and treatment before irreversible damage to neural tissue. However, there is no agreement on the etiopathogenesis, as well as the need for surgery to treat spontaneous SSDH. Here, we report a rare case of spontaneous SSDH with progressive deterioration and symptoms of cauda equina syndrome after ineffective conservative treatment. PATIENT'S CONCERN: A 38-year-old male patient presented with sudden lower back and bilateral leg pain. DIAGNOSIS: A magnetic resonance imaging (MRI) scan on the third day after the onset of symptoms revealed a subdural hematoma from L1 to S1, presenting as hyperintensities on T1 weighted sequences and hypointensities to isointensities on T2 weighted sequences. INTERVENTION: Laminectomy and subdural evacuation were performed immediately. OUTCOMES: An abnormal ligamentum flavum was observed intraoperatively. A histological examination revealed extravasation of blood in the degenerated ligamentum flavum. Postoperatively, the lower limb pain improved immediately. At the 6-month follow-up, the pain and numbness of the lower limb disappeared, and the muscle strength of both legs recovered completely with normal gait. LESSONS: Spontaneous SSDH with ligamentum flavum hematoma was caused by a sudden increase of intravenous pressure, resulting from a marked surge in the intra-abdominal or intrathoracic pressure. Consecutive MRI scans provided valuable information, leading to a diagnosis of spontaneous SSDH. The treatment protocol for spontaneous SSDH should be determined based on the location and stage of the hematoma, as well as the subject's neurological status. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/30896615/Surgical_treatment_of_progressive_cauda_equina_compression_caused_by_spontaneous_spinal_subdural_hematoma:_A_case_report_ DB - PRIME DP - Unbound Medicine ER -