Effect on spine and spinal cord

There is naturally not much space in the spine. The spinal cord fills most of the space with the surrounding cerebrospinal fluid. If a haematoma occurs due to bleeding in the epidural space, this can quickly affect the spinal cord.

While initial pressure can be very painful, but is unlikely to cause any damage, the spread of the haematoma begins to cause neurological symptoms. Depending on the amount of bleeding, the segments below are affected by motor and sensory deficits. At the level of the thoracic vertebrae, the arm and leg regions are conspicuous, below them only the legs.

In addition to movement and sensation, other bodily functions whose control center is in the spinal cord may also be restricted. For example, micturition disorders (micturition = urinary control) are a typical conspicuous feature of severe spinal cord failures. If the vertebral bodies themselves are otherwise healthy, they normally do not suffer any damage from the resulting pressure. The condition of osteoporotic weakened or otherwise already injured vertebral bodies can be worsened by an extensive hematoma.

Therapy/OP

An epidural hematoma is a medical emergency. Both intracranial and spinal localization must be treated immediately and hospitalization must be ensured. The standard therapy here is neurosurgical surgery.

Drug treatment can be used as an accompanying measure, but does not solve the problem as such. During the operation, the skull bone is first opened carefully, which is called trepanation. On the one hand, this allows access to the site of bleeding, and on the other hand, pressure is relieved – which is important for preventing late complications.

After the tissue has been saved from further pressure-induced destruction, the hematoma can be removed. This involves scraping off coagulated blood and aspirating liquid blood. The vessel from which the bleeding originates is sclerosed and then the wound is closed again. When operating on the spinal column, care must be taken of the surrounding nerves that leave the spinal cord and spinal canal laterally.