Treatment Strategies And Prognosis Of Spontaneous Spinal Epidural Hematoma

Objective:To investigate treatment strategies and neurological outcome in patients wi th spontaneous spinal epidural hematoma(SSEH).Methods:From June 2004 to March 2016,42 patients with SSEH who had treatmet in Tianjin Medical University General Hospital were enrolled retrospectively.T here are surgery group(24 cases)and conservative treatment group(18 cases).The neurological function of the patients was assessed by the Department of orthopedics Association(JOA)spinal cord function score(JOA score)and Amer ican Spinal Injury Association Spinal Cord Injury Impairment Scale(ASIA).The JOA score of each patient before and after treatment were calculated,and the neurological function recovery rate of eath patient after treatment was evaluated.Grouped according to ASIA scale for the patients of surgery and conservative treatment,compare the neurological functional recovery in different groups.The effect of operation group and conservative treatment group on the recovery rate of neurological function was compared in the same ASIA scale.According to time interval for onset of symptoms to surgery,patients were divided into<12h group? 12~24h group ??24h group,comparing neurological function recovery rate.Grouped according to the patient's age,sex,length of hematoma,degree of hematoma compression to the spinal cord and the level of hematoma in the vertebral body,the relationship between the factors and the rate of reco very of the neurological function was statistically analyzed.The follow-up time ranged from 4 to 34 months,with an average of 18±6 months.Results:Grouped according to ASIA scale,surgery patients' neurological function re covery rate had statistical significance(F=11.76,p<0.01).Conservative treatment patients' neurological function recovery rate had statistical significance(F=20.25,p<0.01).Compared the neurological function recovery rate between surgery and conservative treatment in the same ASIA scale C,the difference had statis tical significance(t=2.34,p<0.05).in the same ASIA scale D,the difference had statistical significance(t=1.43,p>0.05).Patients were divided into <12h group?12~24h group and ?24h group,comparing neurological function recovery rate,with statistically significant difference(F=11.40,P<0.01).Gender,age,length of hematoma for the recovery of neurological function were no significant line ar correlation(p>0.05),The degree of hematoma compression to the spinal cord was negatively related to the recovery rate of neurological function(p<0.05,r=-0.45).According to the hematoma in the vertebral level position were grouped five groups.The group of lumbar was not statistically significant,for cer vical,cervical and thoracic thoracic,thoracolumbar,four groups were analyzed statistically,the difference was not statistically significant(F=2.55,p>0.05).Conclusion:To patients classification into ASIA scale A?B?C,or progressive decline in ASIA scale,early surgical treatment as soon as possible can achieve good prognosis.To patients classification into ASIA scale D?E,or neurological function recovery short-term trend,conservative management can also be achieve good prognosis.The degree of spinal cord compression is also an important reference factor for surgery and prognosis.The prognosis of surgery patients relate with initial ASIA scale and surgery time interval.It can achieve good prognosis with higher initial ASIA scale and shorter surgery time interval.The prognosis of conservative patients relate with initial ASIA scale.The higher initial ASIA scale the better the prognosis.