• Rahul Raj, Matti Seppälä, and Jari Siironen.
• Helsinki University Hospital, Department of Neurosurgery, Topeliuksenkatu 5, P.B. 266, 00029, HUS, Helsinki, Finland. Electronic address: rahul.raj@hus.fi.
• World Neurosurg. 2016 Jun 1.

BackgroundSpontaneous spinal epidural hematoma (SS-EDH) is a rare neurosurgical emergency. Little is known about predictive factors of outcome in patients suffering from SS-EDH. Here we present a case series of patients operated on for an SS-EDH.MethodsWe reviewed all cases of patients operated on for an SS-EDH between January 2009 and February 2016 in a large academic neurosurgical center. We recorded pre-admission functional status, bleeding characteristics and post-surgery outcome. Good outcome was defined, according to the Nurick score, as at least being able to walk in a way that did not prevent employment. Mean follow-up time was 19 months (SD=25 months).ResultsTen patients, with a mean age of 70 years (SD=10), with SS-EDH were included. The location of SS-EDH was binomially distributed with the highest frequencies in the upper thoracic region (Th3-5) and middle-to-low cervical region (C4-6). Five patients had a poor outcome. Of these, three remained chair bound or bedridden. No statistically significant association could be found between pre-operative characteristics and outcome, but patients with poor pre-operative motor function, thoracic hematoma and more than four involved segments had a remarkably high rate of poor neurological outcome. We could not establish any association between time delay from symptom onset to surgery and outcome.ConclusionIn our series, half of the patients with SS-EDH recovered well after surgery. Although no statistically significant association could be established, hematoma location, size and pre-operative motor function seem to be some of the most important predictive factors of post-operative recovery.Copyright © 2016 Elsevier Inc. All rights reserved.

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