Unilateral biportal endoscopic decompression for acute spontaneous spinal epidural hematoma at the cervicothoracic junction: a case report and literature review.

BACKGROUND

Spontaneous spinal epidural hematoma (SSEH) represents a rare neurosurgical emergency. While conventional open surgical decompression remains the standard of care, it necessitates substantial tissue dissection and is associated with prolonged recovery periods.

METHODS

The patient underwent enhanced magnetic resonance imaging (MRI) confirming SSEH at C7-T2. Surgical decompression and hematoma evacuation were performed using a unilateral biportal endoscopy (UBE) technique under general anesthesia.

RESULTS

UBE was completed successfully in 90 min with an estimated blood loss of 50 mL. The patient demonstrated significant neurological improvement, achieving independent ambulation with a walker by postoperative day 3. At the 6-month follow-up, she attained ASIA grade E with only minimal residual increase in lower limb muscle tone.

CONCLUSIONS

UBE offers a viable minimally invasive alternative to open surgery for SSEH evacuation. This technique provides excellent visualization and precise decompression while preserving spinal stability, resulting in reduced surgical trauma and accelerated neurological recovery.