Nine cases of nontraumatic spinal epidural hematoma.

Nontraumatic spinal epidural hematoma (NSEH) is a rare but potentially serious spinal disease, which progresses inexorably to a catastrophic neurological situation if left untreated. Nine patients (5 males and 4 females, mean age 59.8 years) with NSEH were admitted to our hospital between 1987 and 1997. Clinical data, imaging, and operative results of these patients were analyzed retrospectively. Multilaminectomy was performed to decompress the affected levels. Postoperative neurological evaluation revealed functional improvement in five patients and no significant change in four patients. The most important factors influencing postoperative recovery were the preoperative neurological condition of the patient and the interval from onset of deficit until the operation. Magnetic resonance imaging allows non-invasive and specific diagnosis of NSEH, except in the first 24 hours. Computed tomography myelography with sagittal reconstructions provides specific diagnosis in this period. Combination of these diagnostic imaging modalities allows early diagnosis. Surgical decompression within 24 hours of complete sensorimotor deficit or within 48 hours of incomplete sensorimotor deficit will achieve the optimum outcome.