Spontaneous spinal subdural hematoma: Comparative analysis of clinical features, time course, and outcomes with...

Spontaneous spinal subdural hematoma is rarer and less characterized than epidural hematoma, and comparative data on clinical features and management are limited.

We retrospectively reviewed cases of spontaneous spinal subdural and epidural hematoma diagnosed between 1995 and 2023 at two tertiary hospitals. Neurological status was graded using the American Spinal Injury Association impairment scale for both groups.

Five subdural and 45 epidural cases were included. Headache occurred in 60% of subdural cases and in none of the epidural cases. Admission blood pressure was lower in the subdural group; time to admission was longer in the subdural group, as was time to diagnosis. Hematoma length was similar (median four vertebral levels) for both populations, but spinal canal occupancy rates were lower in the subdural group. Notably, conservative management was used in 80% of subdural cases versus 46.7% of epidural cases. Interestingly, neurological recovery was comparably favorable in both groups.

Subdural and epidural spinal hematomas show distinct presentations and time courses. Headache, delayed presentation, and lower spinal canal occupancy ratios were characteristic of subdural hematomas. Notably, conservative management was appropriate for 80% of spontaneous spinal subdural hematoma but just 46.7% of spontaneous spinal epidural hematoma patients with mild deficits.