Spontaneous Epidural Hematoma during Pregnancy

Spontaneous epidural hematoma during pregnancy is rare but it requires urgent diagnosis and decompressive surgery because the prognosis is mainly linked to the speed of treatment. Reporting the case of a pregnant woman in the 8th month of pregnancy who presented back pain with paraplegia, an MRI was performed on her returning in favor of a compressive hematoma at the D1D2 level. Followed by a D1D2 laminectomy with evacuation of the hematoma. The postoperative period is marked by total neurological recovery.

Uniportal Full-Endoscopic versus Minimally Invasive Decompression for Lumbar Spinal Stenosis: A Meta-analysis

Background In this study, we systematically analyze the effectiveness of the uniportal full-endoscopic (UPFE) and minimally invasive (MIS) decompression for treatment of lumbar spinal stenosis patients. Methods We performed a systematic search in Medline, Embase, Europe PMC, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, China national knowledge infrastructure, and Wanfang Data databases for all relevant studies. All statistical analyses were performed using Review Manager version 5.3. Results A total of 9 articles with 522 patients in the UPFE group and 367 patients in the MIS group were included. The results of the meta-analysis showed that the UPFE group had significantly better results in hospital stay time (mean difference [MD]: –2.05; 95% confidence interval [CI]: –2.87 to –1.23), intraoperative blood loss (MD: –36.56; 95% CI: –54.57 to –18.56), and wound-related complications (MD: –36.56; 95%CI: –54.57 to –18.56) compared with the MIS group, whereas the postoperative clinical scores (MD: –0.66; 95%CI: –1.79 to 0.47; MD: –0.75; 95%CI: –1.86 to 0.36; and MD: –4.58; 95%CI: –16.80 to 7.63), satisfaction rate (odds ratio [OR] = 1.24; 95%CI: 0.70–2.20), operation time (MD: 30.31; 95%CI: –12.55 to 73.18), complication rates for dural injury (OR = 0.60; 95%CI: 0.29–1.26), epidural hematoma (OR = 0.60; 95%CI: 0.29–1.26), and postoperative transient dysesthesia and weakness (OR = 0.73; 95%CI: 0.36–1.51) showed no significant differences between the two groups. Conclusions The UPFE decompression is associated with shorter hospital stay time and lower intraoperative blood loss and wound-related complications compared with MIS decompression for treatment of lumbar spinal stenosis patients. The postoperative clinical scores, satisfaction rate, operation time, complication rates for dural injury, epidural hematoma, and postoperative transient dysesthesia and weakness did not differ significantly between two groups.

Cervical epidural hematoma with Brown-Sequard syndrome caused by an epidural injection: a case report

Epidural hematoma with Brown-Sequard syndrome caused by an epidural injection is a rarely found condition in the emergency department (ED). We report an unusual case of Brown-Sequard syndrome in a 55-year-old man who presented at the ED with right-sided weakness and contralateral loss of pain and temperature sensation after a cervical epidural injection for shoulder pain. Cervicla spine magnetic resonance imaging showed an epidural hematoma from C4 to C6. After admission, his right hemiparesis and contralateral sensory loss improved within eight days, and surgical decompression was not required. Diagnosing spinal lesions in the ED is challenging, especially in patients with acute neurological signs requiring immediate evaluation for stroke. In this case, definite hemiparesis and some contralateral sensory loss were noted. Therefore, a potential spinal lesion was suspected rather than a stroke. This case emphasized the importance of conducting a focused neurological examination after history taking.

Ten questions about intracranial epidural hematoma

Introduction: Intracranial epidural hematoma (EH) is considered a neurosurgical emergency. Its knowledgement has been increasingly prominent in literature. Methods: a literature review was performed on ten questions related to intracranial EH, such as age, sex, causes, location, imaging findings, neurological examination, lucid interval, hematoma size, treatment and prognosis. Conclusion: EH affects more young adult males. It does not cross the lines of cranial sutures. The lucid interval has been commonly described, however, it is not pathognomonic of EH, and may occur in other lesions of expanding mass. The computed tomography (CT) scan of the skull has been the exam of choice. The size influences prognosis and sequelae, when small and asymptomatic the treatment has been conservative and, if bulky, it requires surgical intervention. Early recognition and appropriate treatment for a good prognosis is of great importance.

Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis

Background With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors. Methods Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test. Results The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications. Conclusion Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.