Risk factor analysis and surgical outcomes of Acute Spontaneous Spinal Subdural Haematoma. An institutional experience of four cases and literature review.

Abstract Objectives Spontaneous Spinal Subdural Haematoma (SSSDH) is exceedingly rare with significant morbidity in the majority of cases. Acute neurological deficit in the context of a SSSDH is considered a neurosurgical emergency. The authors performed a literature review and compared this to our institutional experience to evaluate the risk factors and neurological outcomes of SSSDH. Methods We retrospectively collected the medical, radiological and surgical information of four cases of SSSDH that were operated on in our neurosurgical unit. A literature review of surgically managed SSSDH and their neurological outcomes was performed. Ordered logistic regression statistics was used to study the risk factors influencing the post-operative Domenicucci Grade. Results A total of 112 patients were evaluated, with a female: male ratio of 1.3:1. Mean patient age was 60.25 years old. Our analysis of the data showed that the cohort of patients presenting with bladder dysfunction in addition to paraparesis were found to have worse neurological outcomes post-operatively. Adjusted analysis identified three clinical characteristics that influenced surgical outcome: cervical SSSDH (P=0.029), neurological deficit ( Conclusion This review shows that patients aged 60 and above and on anticoagulation are at an increased risk of sustaining a spontaneous subdural spinal haematoma without history of trauma. To our knowledge, this is also the first study to show a presenting symptom of bladder dysfunction as a significant risk factor for poor surgical outcome in SSSDH. As such, our study supports surgical evacuation of acute SSSDH in the presence of these risk factors.