Research Fellow University of Arizona Phoenix, Arizona, United States
Introduction: Spinal epidural Hematomas (SEH) represent a rare spinal emergency with a frequency of less than 1% of spinal space-occupying lesions with even less documented occurrence during pregnancy. Despite SEH infrequency during pregnancy, it presents an increased risk of mortality/morbidity to both mother and child. It is also challenging to diagnose and treat during pregnancy as it risks two lives. A comprehensive review to understand this condition and the treatment options for clinicians treating this pathology.
Methods: A comprehensive systematic review via PubMed, Google Scholar, Scopus, and OVID was performed for articles relevant to managing spinal epidural hematomas. The outcomes analyzed were the mode of presentation, neurological findings, diagnostic tools, location of the hematoma, the treatment proposed, and recovery. Data were extracted from 14 selected publications.
Results: Fourteen case reports were included, reporting 15 patients with SEH. The mean age was 29.46 years, mean gestational age was 33.46 complete weeks—four patients presented in the second trimester and 11 in the third. Fourteen patients presented with pain followed by neurologic deterioration, three in the subacute phase, and the remaining showed after-hours developing symptoms. (MRI) was the primary diagnostic tool in all cases. The thoracic region was the most commonly affected (n=8), followed by the cervical (n=4), Cervicothoracic (n=2), and Thoracolumbar(n=2). Four patients presented with risk factors, including previous SSEH, preeclampsia, antiphospholipid syndrome, and (HELLP) Syndrome. The average time from diagnosis to decompression was 9.7 hours (n=8). Pregnancy was maintained in two cases, including a twin pregnancy following Surgical spinal decompression. The remaining had emergent cesarian delivery followed by spinal cord decompression with hematoma removal. Neonatal outcomes were excellent in all cases. At the last follow-up, 50% of patients had a complete neurological recovery, and the reaming had a near full recovery with no patient experiencing deterioration of symptoms.
Conclusion : Spinal Epidural Hematoma during pregnancy is an acute neurologic emergency that mandates prompt recognition and treatment. The diagnosis should be suspected of sharp and significant back or neck pain with a progressive neurological deficit. Functional recovery is related directly to the interval between symptom onset and surgical decompression.
