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2015 ; 5
(5
): e52-8
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Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing
the Possible Etiologic Role of Venous Congestion
#MMPMID26430602
Mattei TA
; Rehman AA
; Dinh DH
Global Spine J
2015[Oct]; 5
(5
): e52-8
PMID26430602
show ga
Study Design?Case report and literature review. Objective?Spinal subdural
hematomas are rare events that often progress with severe neurologic deficits.
Although there have been several case reports in the literature of spontaneous
spinal subdural hematomas in the setting of anticoagulation, antiplatelet
therapy, or coagulation disorders, the exact pathophysiology of such phenomena
remains obscure. Methods?We present the first report of a subdural hematoma after
a percutaneous vertebroplasty and provide a comprehensive review on the anatomy
of venous drainage of the vertebral bodies with emphasis on the possible effects
of venous congestion caused by cement obstruction. Results?Because the subdural
hematoma occurred in the absence of major cement extravasation to the spinal
canal and two levels above the site of the vertebroplasty, we discuss the
possible role of venous congestion as the main etiologic factor leading to
rupture of the fragile, valveless radiculomedullary veins into the subdural
space. Conclusions?The reported case supports a possible new pathophysiological
scheme for the development of spinal subdural hematoma in which venous congestion
plays a pivotal etiologic role. The reported findings suggests that future
anatomical and histologic studies investigating the response of the
radiculomedullary veins to congestive venous hypertension may shed new light into
the pathophysiology of spinal subdural hematomas.