Spontaneous resolved cervical spine epidural hematoma: A case report

BACKGROUND Cervical spine epidural hematomas (CSEH) are rare, and surgical intervention is typically required. Here, we present the rare case of a CSEH resulting from chiropractic manipulation successfully treated conservatively. CASE DESCRIPTION A 44-year-old female with cervical myelopathy presented with a mild quadriparesis following manipulation by a chiropractor. Although magnetic resonance (MR) documented a CSEH, the lesion was treated nonsurgically as the patient refused operative intervention. Four days later, the patient demonstrated spontaneous improvement. Furthermore, the 1-month post manipulation cervical MR showed resolution of the CSEH mass effect, and her myelopathy fully resolved. CONCLUSION Few studies document the efficacy of conservative treatment of CSEH. In this case, a patient with cervical myelopathy presented with a mild quadriparesis following chiropractic manipulation. Although MR documented a CSEH, she refused surgery, but fortunately improved neurologically within the next 4 days and was intact within 1 postoperative month. We recommend performing more powerful studies with large sample size to better define criteria for conservative vs. surgical treatment of CSEH.