Our Summary

This research paper studies a rare and debilitating condition called Spontaneous spinal epidural hematoma (SSEH), which is especially unclear in how to treat in older patients. The researchers looked at medical records of patients aged 80 and above who underwent a specific type of surgery called laminectomy to treat SSEH. They found that around half of these patients were taking blood-thinning medications and had an abnormal blood clotting test result, indicating a high risk of bleeding. Most of these patients were experiencing a decline in their motor skills when they were admitted to the hospital. They found that 4.5% of these patients died in the hospital and 9.1% died within 90 days of the surgery. However, they also noticed that the patients’ motor skills significantly improved after the surgery. In some cases, a second surgery was needed due to the return of the hematoma. The use of blood-thinning medications and abnormal blood clotting were found to increase the risk of this happening. The researchers concluded that immediate surgery can provide significant benefits for older patients with SSEH, but risks associated with certain factors, like the use of blood-thinning medications, need to be considered.

FAQs

  1. What is Spontaneous spinal epidural hematoma (SSEH) and how common is it in older patients?
  2. How does the use of blood-thinning medications impact the treatment of SSEH in elderly patients?
  3. What were the key findings of the research on the effectiveness of immediate surgery for elderly patients with SSEH?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal decompression is to follow post-operative care instructions carefully, including avoiding heavy lifting, maintaining good posture, and attending follow-up appointments. It is also important to stay active and engage in regular exercise to strengthen the muscles supporting the spine and prevent future issues. Additionally, maintaining a healthy weight and practicing good body mechanics can help alleviate pressure on the spine and reduce the risk of recurrence.

Suitable For

Patients who are typically recommended spinal decompression are those who are experiencing symptoms such as chronic back pain, herniated discs, sciatica, spinal stenosis, degenerative disc disease, and other spinal conditions. Additionally, patients who have not seen improvement with conservative treatments such as physical therapy, medication, or injections may be candidates for spinal decompression. Older patients with conditions such as SSEH may also be recommended for spinal decompression surgery, but the risks associated with their age and medical conditions need to be carefully considered.

Timeline

Before spinal decompression:

  1. Patient experiences symptoms such as back pain, numbness, tingling, or weakness in the arms or legs.
  2. Patient undergoes diagnostic tests such as MRI or CT scans to determine the cause of their symptoms.
  3. Doctor recommends spinal decompression as a treatment option for conditions such as herniated discs, spinal stenosis, or degenerative disc disease.

After spinal decompression:

  1. Patient undergoes spinal decompression surgery, which can be done through minimally invasive techniques or traditional open surgery.
  2. Patient may experience some pain and discomfort immediately following the surgery, but this typically improves over time.
  3. Physical therapy and rehabilitation may be recommended to help the patient regain strength and mobility in the affected area.
  4. Patient may experience improvements in their symptoms, such as reduced pain, improved range of motion, and restored function in the affected limbs.
  5. Follow-up appointments with the doctor are scheduled to monitor the patient’s progress and address any concerns or complications that may arise.

What to Ask Your Doctor

  1. What is spinal decompression and how does it work to relieve pressure on the spinal cord and nerves?
  2. Am I a candidate for spinal decompression therapy? Are there any specific criteria or conditions that would make me ineligible for this treatment?
  3. What are the potential risks and complications associated with spinal decompression therapy?
  4. How long does it typically take to see improvement in symptoms after undergoing spinal decompression therapy?
  5. Are there any alternative treatments or therapies that I should consider in addition to or instead of spinal decompression?
  6. How many sessions of spinal decompression therapy will I need, and how often will I need to undergo treatment?
  7. What is the success rate of spinal decompression therapy for my specific condition, and what are the long-term outcomes?
  8. Will I need to make any lifestyle or activity modifications after undergoing spinal decompression therapy?
  9. Are there any specific exercises or physical therapy techniques that can help enhance the benefits of spinal decompression therapy?
  10. What should I do if I experience any new or worsening symptoms during or after undergoing spinal decompression therapy?

Reference

Authors: Lenga P, Knittelfelder M, Gülec G, Kiening K, Unterberg AW, Ishak B. Journal: Acta Neurochir (Wien). 2023 Apr;165(4):905-913. doi: 10.1007/s00701-022-05457-7. Epub 2022 Dec 26. PMID: 36571626