Spinal epidural haematoma; factors influencing outcome

Spinal epidural haematoma (SEH) causing spinal cord compression is potentially a cause of long-term neurological disability. We reviewed the relevant literature with the intention of establishing the factors that influence long-term outcome and the timeframe within which operative intervention must be undertaken for optimal results.

A total of 1177 papers were identified using PubMed among which 31 papers were selected and analysed. The grades of neurological deficit, pre- and post-operatively, were classified according to the Frankel grade. The timing of surgery was from the onset of first symptoms of incomplete cord lesions and the onset of paraplegia with complete lesions.

The two main factors that determine long-term outcome were the degree of neurological deficit at the time of treatment and the timing of surgical intervention. Fifty-six per cent of patients who had 'incomplete SCI' made a full neurological recovery as compared to 27% when the initial injury was 'complete SCI' (Chi square, p < 0.001). Operative intervention within 12 h of onset of symptoms gave the best chance of recovery to 'normal' (Frankel E), even in patients who were paraplegic (Frankel A) pre-operatively.

Recovery to 'normal', or 'incomplete SCI', is possible with surgical decompression if performed within 12 h, even if the patient is paraplegic pre-operatively. If the diagnosis is suspected, immediate investigations must be undertaken and/or arrangements for appropriate referral must be made urgently to ensure diagnosis and treatment in the tertiary centre within the 12 h window.