A spinal subdural hematoma (SDH) is a collection of blood that may compress nerve roots near the spine or the spinal cord itself. Any collection of blood in the body is cause for concern, but it can be especially problematic when it occurs around the spine. The resulting compression is serious and may lead to paralysis or permanent loss of neurological function if not detected and treated as soon as possible.
What Causes the Condition?
Anything that results in a hemorrhage around the spinal cord may result in a spinal subdural hematoma. Blood accumulation in the spine is more common in individuals who have experienced some type of acute trauma to the spine.
Patients who are undergoing anticoagulant therapy, which reduces the body’s ability to clot, or thrombolytic therapy, which involves the use of drugs that dissolve blood clots, are also at an increased of developing an SDH. Having a lumbar puncture (spinal tap) to collect and examine spinal fluid also increases the risk of blood collection around the spine. Additional risk factors include:
- Experiencing a severe spike in high blood pressure (a hypertensive crisis)
- Having an unusual susceptibility to bleeding (bleeding diathesis)
- Taking anticoagulation medications
- Having coagulopathy (a bleeding disorder that affects blood’s ability to clot)
What Are the Possible Signs and Symptoms?
Signs you may have a spinal hematoma include sudden weakness, numbness, or pain that’s out of the ordinary, especially if you don’t normally experience back-related discomfort. You may also notice local or radiating back pain or abdominal tenderness. Symptoms may develop quickly or over several hours. If a spinal hematoma is serious, you may experience the following symptoms:
- General muscle weakness
- Difficulty walking or maintaining balance
- Loss of bowel/bladder control
- Sudden paralysis
How Is a Spinal Hematoma Diagnosed?
SDHs are diagnosed with image tests. If an MRI is not immediately available, a CT myelography may be done. This is a test where a contrast dye is injected to identify the location of a possible spinal hematoma.
What Are the Treatment Options?
There are no medications or other conservative options that can treat a spinal hematoma. The only treatment option is surgical drainage of the collected blood to relieve pressure on the spinal cord or nearby nerve roots. Typically, a guided device is used to guide the Los Angeles spine surgeon to the correct location while a needle is inserted to drain the accumulated blood. Treatment may also involve:
- Laminectomy surgery (removal of part of a vertebra covering the spinal canal) to access the hematoma
- Medications after surgery to restore clotting capabilities (for hematomas caused by clotting issues)
- Blood platelets for patients with thrombocytopenia (low blood platelet count that affects clotting abilities)
- Incision into the outer membrane of the spinal cord (dura) or the spinal cord itself (depending on the location of the hematoma)
While there is always a risk of developing a spinal hematoma, especially if you experience some type of trauma or have a spinal tap, it’s an extremely rare occurrence. There are no preventative measures. However, making an effort to avoid direct trauma to your spine and being mindful of unusual symptoms after having a spinal tap may minimize your risk of experiencing serious complications from a hematoma.
Though spinal hematomas are rare, there are many other spinal conditions that are far more common and require minimally invasive surgery. At The Spine Institute Center, we specialize in various fusion and non-fusion procedures, from spinal cord stimulation to decompression surgery. Los Angeles residents can trust in Dr. Hyun Bae and his team of expert surgeons to diagnose the source of their pain and help them find relief. Call 310-828-7757 today to schedule an appointment.