Spinal extradural haematoma or spinal epidural hematoma (SEH) is bleeding into the
epidural space
In anatomy, the epidural space is the potential space between the dura mater and vertebrae (spine).
The anatomy term "epidural space" has its origin in the Ancient Greek language; , "on, upon" + dura mater also known as "epidural cavity", "e ...
in the spine. These may arise spontaneously (e.g. during childbirth), or as a rare complication of
epidural anaesthesia
Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians an ...
or of surgery (such as
laminectomy
A laminectomy is a surgical procedure that removes a portion of a vertebra called the lamina, which is the roof of the spinal canal. It is a major spine operation with residual scar tissue and may result in postlaminectomy syndrome. Depending ...
). Symptoms usually include back pain which radiates to the arms or the legs.
They may cause pressure on the spinal cord or
cauda equina
The cauda equina () is a bundle of spinal nerves and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth sacral nerve pairs, and the coccygeal nerve, all of which arise from the lumbar enlarg ...
, which may present as pain, muscle weakness, or dysfunction of the bladder and bowel.
Pathophysiology
The anatomy of the epidural space is such that spinal epidural hematoma has a different presentation from intracranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue and a network of large, thin-walled veins, referred to as the epidural venous plexus. The source of bleeding in spinal epidural hematoma is likely to be this venous plexus.
Diagnosis
The best way to confirm the diagnosis is
MRI
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
.
[ Risk factors include anatomical abnormalities and bleeding disorders.
]
Treatment
Treatment is generally with emergency surgery.[ The risk following epidural anaesthesia is difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics.
]
References
{{Reflist
Spinal cord disorders