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Spinal Hematoma Treatment & Management

  • Author: Rod J Oskouian, Jr, MD; Chief Editor: Brian H Kopell, MD  more...
Updated: Nov 10, 2015

Surgical Therapy


Surgical treatment varies with individual physicians and the underlying pathology. Some surgeons believe that urgent clot evacuation is necessary, while others contest that early exploration damages otherwise viable spinal neurons.

Surgeons who believe in clot evacuation operate immediately upon diagnosing a clot. Their rationale assumes an urgent need to remove mass effect and pressure from the spinal cord.

Less aggressive surgeons believe that the neurologic deficit should plateau before removing the clot to keep from damaging viable tissue.

Regardless of the timing, both groups of surgeons believe that the underlying pathology must be addressed. Any accompanying disorders, such as clotting problems, should be corrected as soon as possible. Intraspinal tumors should be surgically removed using the tenets of individual tumor management, while AVMs are managed by embolization, surgical removal, or a combination of those modalities.

Because of the paucity of cases, empirical data do not exist to clarify which treatment course provides a better outcome.


Outcome and Prognosis

Too few data are available to derive solid outcome and prognosis figures for this disease. As noted above, however, the ultimate outcome of a patient correlates strongly with their initial neurological status; in other words, a patient with minimal findings upon presentation will likely experience a much better outcome than a patient who presents with a significant neurological deficit.


Future and Controversies

Spinal cord hematoma or hematomyelia is a fairly rare entity that is usually caused by some underlying pathology or disease process. These causative diseases include AVMs, coagulopathies, tumors, syringomyelia, and vasculitis. No associated problems occur in a subset of these patients.

Clinical presentation is usually a sudden onset of spinal pain accompanied by neurological deficits correlative with the site of the clot. Treatment is aimed at correcting the underlying pathology or clotting disorder and at removing the clot. Timing of treatment and its results are still controversial.

Contributor Information and Disclosures

Rod J Oskouian, Jr, MD Consulting Physician, Swedish Neuroscience Specialists, Swedish Neuroscience Institute, Seattle

Rod J Oskouian, Jr, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, North American Spine Society, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.


Charles E Rawlings III, MD Consulting Surgeon, Department of Neurosurgery, Rawlings Neurosurgical Consulting

Charles E Rawlings III, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, International Parkinson and Movement Disorder Society, Congress of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from St Jude Neuromodulation for consulting; Received consulting fee from MRI Interventions for consulting.

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This T1-weighted sagittal MRI is from a 19-year-old man with 4-month history of progressive motor loss and an inability to ambulate. He underwent spinal biopsy that confirmed an intramedullary glioblastoma.
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