Post-traumatic subdural spinal hematomas: Two case reports and systematic review of the literature

Abstract Background and Importance: State the significance of the issue and importance of the case(s) Spinal subdural hematomas (SDH) are rare and potentially life-threatening occurrences. Traumatic SDH are the least common form of SDH, with few cases reported in the literature. We describe our management of two cases of post-traumatic acute SDH in elderly patients under oral anticoagulant therapy, highlighting the importance of closely monitoring patients of this category with minor spinal trauma. Clinical Presentation Define the case(s) presented, pertinent attendant issues, and observations An 88-year old woman patient in therapy with oral anticoagulant presented sudden severe low back pain and rapid onset of complete paraplegia and urinary retention after a fall. MRI showed a subdural hematoma, extending from T5 to sacrum. The patient refused surgery and was managed conservatively. A 90-year old woman in therapy with oral anticoagulant presented a rapid and progressive paraplegia and urinary retention one day after a fall. MRI showed acute subdural hematoma extending from T8 to L4. The patient underwent an emergency evacuation through T12 laminectomy. Discussion Both patients gradually recovered, although they had different treatments and different outcome. Early diagnosis is a key to managing the condition before damage to neural tissue become irreversible. A literature review depicts the heterogeneity of management approaches; to date, there is no agreement on the need for surgery to treat SDH. Conclusion The cases highlight the importance of not underestimating minor spinal injury in the elderly who are in anticoagulant therapy. In such cases, a spinal bleeding should be suspected. We recommend that the patient be closely monitored, similarly as for the head injury protocols.