Optimizing Management of Spontaneous Cervical Epidural Hematoma: The Role of Early Intervention in Functional Recovery.

OBJECTIVE

To present 3 cases of spontaneous cervical epidural hematoma (SCEH) with acute neurological deterioration that achieved excellent functional recovery after surgical decompression, and to evaluate the influence of surgical timing on outcomes through a literature review.

METHODS

We report on 3 patients diagnosed with SCEH via cervical magnetic resonance imaging (MRI) following acute-onset neck pain, followed by hemiparesis or hemiplegia. Surgical decompression was performed at 19, 6, and 10 hours after symptom onset, respectively. A comprehensive literature review was also conducted to assess the relationship between surgical timing and neurological outcomes in SCEH.

LITERATURE SEARCH STRATEGY: We performed a literature search using PubMed as the primary database, complemented by Google Scholar, covering the period from January 1980 to December 2024. Keywords included "spinal epidural hematoma," "cervical," "spontaneous," and "surgery." Inclusion criteria were case reports, case series, or reviews describing SCEH with surgical or conservative management and reported outcomes.

RESULTS

All 3 patients demonstrated complete neurological recovery despite presenting with severe motor deficits and undergoing surgery at different times. Their recovery periods ranged from 11 to 90 days. Our literature review, which included 158 cases, consistently indicated that surgical timing is a critical factor influencing outcomes. Specifically, 83.2% of patients showed neurological improvement with surgery within 12 hours, while 68.9% improved when operated on between 12 and 24 hours1). Another study reported 91% favorable outcomes with ultra-early intervention (within 6 hours), compared to 33% when delayed beyond 48 hours2).

LIMITATIONS: The proposed treatment algorithm is based on a small number of institutional cases combined with data from a narrative literature review. A formal meta-analysis or quantitative pooled analysis was not performed; therefore, the generalizability of the algorithm should be interpreted with caution.

CONCLUSIONS

Prompt surgical decompression, ideally within 12-24 hours, can result in excellent functional recovery in SCEH, even in patients with severe initial neurological deficits. Early recognition of stroke-mimicking symptoms and urgent MRI evaluation are crucial for achieving optimal outcomes.