J Korean Soc Spine Surg.  2003 Jun;10(2):191-195. 10.4184/jkss.2003.10.2.191.

Spinal Epidural Hematoma Associated with Cervical Fracture in Ankylosing Spondylitis

• Jeon TS
• Chung WY
• Lee WS
• Kim WS
• Kim NH
• Kim YC
• Cho SJ

• KMID: 2003217
• DOI: http://doi.org/10.4184/jkss.2003.10.2.191

Abstract

A spinal epidural hematoma is a very rare condition, but it is a neurological emergency that requires urgent investigation and treatment, as it can lead to neurological sequelae, such as quadriplegia, in many cases. With a traumatic epidural hematoma associated with ankylosing spondylitis, the clinical course progresses more rapidly, and the prognosis is thought to be worse than that without ankylosing spondylitis. The mainstay of treatment is an urgent surgical decompression and evacuation of the hematoma, via a laminectomy, in the patients' that develop progressive neurological deterioration. However, there have only been a few reports on the successful conservative treatment of selective patients, with incomplete and nonprogressing deficits, where the symptoms and signs have resolved without surgery. We report on a patient with a traumatic epidural hematoma, associated with cervical fracture in ankylosing spondylitis, treated conservatively with an excellent neurological outcome.

Keyword

Epidural hematoma; Cervical fracture; Ankylosing spondylitis

MeSH Terms

Decompression, Surgical
Emergencies
Hematoma
Hematoma, Epidural, Spinal*
Humans
Laminectomy
Prognosis
Quadriplegia
Spondylitis, Ankylosing*

Figure

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  Fig. 1. Initial radiograph of the cervical spine showing deformity of “ Bamboo spine” and fracture of sixth cervical spine.

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  Fig. 2. A. T1-weighted sagittal magnetic resonance imaging (MRI) demonstrating a large isointense cervical spinal epidural hematoma extending from C4 to C7 about 4cm in size with anterior displacement of the spinal cord. Fig. 2. B. T2-weighted MRI showing low signal spinal epidural hematoma.

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  Fig. 3. Simple radiograph of the cervical spine showing well preserved contour and bony union of sixth cervical spine.

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  Fig. 4. T2-wighted sagittal MRI showing complete resolution of the previous hematoma at 3-months follow-up.

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