Introduction: Spontaneous spinal epidural hematomas (SSEH) are a rare and morbid entity whose prognosis is often adversely affected by a delayed diagnosis and surgical intervention. Correlation with time of intervention and neurological recovery is not clearly described in the literature.

Methods: We retrospectively reviewed the records of 14 patients who underwent surgical decompression of SSEH over 10-year duration. Diagnosis was established on MRI scans, intraoperative findings, and in addition to histopathological examination. The patient's case presentation, relevant laboratory examination, radiological image, treatment, pathological result, and neurological outcome were reviewed

Results: Fourteen patients, 6 were males, with a mean age of 54.1 years (range; 18-92 years). All patients had spontaneous onset, and two patients were on anticoagulant therapy. The most common presentation was paraplegia (n=8) with AIS ranging from A to D, paraparesis (n=3) with AIS = A, B and C, Quadriplegia (n=1) with AIS = C, and Quardriparesis (n=2) with AIS = B. All patients had spinal cord signal changes on T2-weighted MRI scans varied from 1 to 4 vertebral levels. Response to surgery was favorable in 13 of our patients at 6-month follow up (AIS = E in seven patients, D in four, and C in two) except for one patient that didn’t improve. The mean improvement of their AIS was 2.31 degrees at six months and 2.5 degrees at more than one year (ranging from 2-4 degrees), despite poor functional status on presentation and late decompression that occurred at a mean of 21. Eight hours after onset of deficit. The spinal cord changes persisted, but markedly decreased in 5 patients on postoperative MRI scan at 6-month follow up. All patients had favorable neurological outcome on a longer follow up, except for the outlier patient.

Conclusions: Significant neurological recovery after surgical decompression of SSEH can be achieved despite the significant preoperative neurological deficits, spinal cord changes on MRI, and delayed timing of intervention.

Patient Care: Our series had encouraging results after operative intervention for complete deficits arising from cord compression within 24 hours. This holds especially true in a young patient, as even a delayed presentation of a complete deficit may result in an independent or partially dependent patient with a significant gain in quality of life. MRI study and urgent surgical decompression must be considered when suspect SSEH.

Learning Objectives: We present a retrospective of surgically eligible cases of posterior spontaneous spinal epidural hematoma, and attempt to determine the correlation between the timing of surgical intervention and changes in the spinal cord signal on magnetic resonance imaging (MRI) with the neurological outcome.

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