Identifying poor prognostic factors in patients with spontaneous spinal epidural hematoma: Insights from 47 cases at a single institution.

OBJECTIVE

To identify clinical and perioperative factors associated with poor neurological outcomes in spontaneous spinal epidural hematoma (SSEH).

METHODS

We retrospectively reviewed 47 consecutive SSEH patients treated from 1995 to 2024 at two centers. Neurological status was graded using the ASIA Impairment Scale (AIS). Good outcome was defined as AIS D/E at final follow-up; poor outcome as AIS A-C. Demographic characteristics, comorbidities, symptoms, imaging findings, treatment, and perioperative variables were statistically compared between outcome groups.

RESULTS

The cohort comprised 20 men and 27 women (median age 69 years). Twenty-six patients underwent surgery and 21 were managed conservatively. All conservatively managed patients and 22/26 surgically treated patients achieved good outcomes. In the surgical group, perioperative hypotension requiring continuous catecholamines and a history of cardiovascular disease (CVD) were significantly associated with poor outcome (p = 0.00154 and p = 0.0278, respectively). Age, sex, lifestyle comorbidities, admission severity, hematoma extent, and canal occupancy ratio were not significantly associated. Time to surgery trended longer in the poor-outcome subgroup.

CONCLUSION

In SSEH, perioperative hypotension and CVD comorbidity are associated with worse neurological recovery. Vigilant hemodynamic management-especially around anesthetic induction-may help preserve spinal cord perfusion and improve outcomes.