{"paper_id":"40ede204-42f7-47a5-96ba-9f97bc8ea2e2","body_text":"Conservative management of spontaneous thoracolumbar epidural hematoma: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Conservative management of spontaneous thoracolumbar epidural hematoma: a case report Menglong Jia, Shan Gao, Longtan Yu, Guangbin Ma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7944394/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Dec, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted 9 You are reading this latest preprint version Abstract Background Spontaneous spinal epidural hematoma (SSEH) is an exceedingly rare clinical entity often associated with neurological deficits, for which surgical intervention remains the mainstay of treatment. We report a novel case successfully managed through complete conservative therapy. Case Presentation A 59-year-old Chinese male with a medical history of hypertension, chronic smoking, and alcohol use presented to our institution with acute-onset low back pain accompanied by bilateral lower limb weakness and hypoesthesia persisting for 30 minutes. Diagnostic imaging (CT and MRI) revealed a thoracolumbar epidural hematoma (T11-L1 distribution). Contrary to conventional management paradigms, we implemented a comprehensive conservative management protoco. Remarkably, complete resolution of symptoms and spontaneous hematoma absorption were achieved within 20 days. Conclusion This case demonstrates that select SSEH cases may achieve favorable outcomes through conservative management without surgical decompression. Spontaneous Spinal Epidural Hematoma Spontaneous Absorption Non-surgical Treatment Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Spinal epidural hematoma (SEH), classically considered a well-documented complication of spinal procedures, primarily results from inadequate intraoperative hemostasis or compromised postoperative drainage [ 1 ]. In contrast, spontaneous spinal epidural hematoma (SSEH) represents a rare clinical entity with an estimated annual incidence of 0.1 per 100,000 individuals, characterized by idiopathic onset and poorly understood pathophysiological mechanisms [ 2 ]. Typical manifestations include acute-onset cervicodorsal or lumbosacral pain accompanied by rapidly progressive neurological deficits secondary to spinal cord compression. This condition's non-specific presentation often leads to significant diagnostic challenges. The clinical manifestations can easily confound attending physicians, as similar symptoms may also present in other clinical entities, including but not limited to cerebrovascular accidents, myocardial infarction, and meningitis, potentially leading to irreversible neurological sequelae when therapeutic intervention is delayed. Current management paradigms prioritize surgical decompression as the gold-standard intervention for SSEH [ 3 ], with limited literature documenting successful non-surgical management. Notably, we present a case of spontaneous thoracolumbar epidural hematoma (T10-L1 distribution) that achieved complete clinical resolution through conservative measures. The patient demonstrated full neurological recovery (ASIA Impairment Scale improvement from Grade C to E) and radiological hematoma clearance within a 20-day observation period, as confirmed by serial MRI examinations. This case highlights the potential viability of watchful waiting protocols in select SSEH presentations, particularly when surgical contraindications exist or in resource-limited settings. Our findings urge spinal specialists to consider individualized therapeutic strategies while advocating for further investigations to establish evidence-based selection criteria for non-operative management. Case presentation A 59-year-old man with a history of hypertension and a long-term habit of smoking and drinking presented with acute thoracolumbar pain accompanied by lower limb weakness. These symptoms occurred when he was doing morning activities 30 minutes ago, and then he was transported to the emergency department by ambulance. The pain intensity reached a significant score of 8 on the Visual Analogue Scale (VAS) (with a full score of 10). Imaging revealed a 5.7 cm non-enhancing extradural hematoma at T11-L1 causing spinal canal stenosis and conus medullaris compression, with laboratory findings showing mild erythrocytopenia (4.19×10¹²/L) and normal coagulation profile. Despite presenting with significant neurological impairment (right/left lower limb muscle strength grades 4/3), conservative management was initiated due to stable neurological status, involving strict bed rest, methylprednisolone (80mg IV), mannitol, sodium aescinate, and adjunctive traditional Chinese medicine hot compresses. Remarkable recovery ensued: pain subsided within 24 hours (VAS 4→0), ambulation restored by day 6, and complete neurological recovery (ASIA Grade D→E) with hematoma resolution on 20-day follow-up MRI. This case demonstrates that select spontaneous spinal epidural hematomas without neurological progression may achieve full recovery through monitored conservative protocols combining anti-edema therapy, neuroprotection, and physical rehabilitation, challenging the traditional surgical imperative while underscoring the importance of individualized neurological surveillance in non-operative management. Discussion and conclusions Spontaneous spinal epidural hematoma (SSEH) predominantly affects middle-aged and elderly populations with a slight male predominance. Current evidence suggests multifactorial etiologies including hypertension, coagulation disorders, anticoagulant use, and arteriovenous malformations, though the precise pathomechanisms remain elusive [ 4 ]. The presented case involved a hypertensive patient with irregular medication adherence (admission BP: 190/110 mmHg), yet Groen et al. [ 5 ] demonstrated no statistical correlation between hypertension prevalence in SSEH cohorts versus controls, suggesting acute pain-induced blood pressure elevation might better explain such observations. Hemorrhagic origins remain debated: arterial rupture typically manifests rapid neurological deterioration, while venous bleeding often stabilizes early [ 6 ]. Bakker et al. [ 7 ] anatomically favors venous sources, particularly emphasizing posterior vertebral plexus prominence in lower thoracic regions of elderly patients—consistent with our case's non-progressive neurological deficits indicative of venous origin. SSEH typically presents with acute axial pain accompanied by sensorimotor deficits in clinical settings, necessitating comprehensive differential diagnosis from conditions like intracranial lesions and aortic dissection. Although clinical manifestations may provide preliminary diagnostic clues, imaging modalities such as CT or MRI remain indispensable for definitive confirmation, underscoring their pivotal role as the gold standard in clinical decision-making [ 8 ]. MRI remains diagnostic gold standard, demonstrating longitudinal epidural masses; emergency CT may reveal hyperdense lesions from hemosiderin deposition, as observed in this patient (T11-L1 hyperdensity) accompanied by mild erythrocytopenia (4.19×10¹²/L), collectively supporting acute hematoma formation. Contrast-enhanced MRI further confirmed non-enhancing lesions, excluding vascular malformations. Therapeutic consensus prioritizes surgical decompression within 48 hours via traditional laminectomy or emerging endoscopic techniques [ 9 – 10 ]. However, conservative management proves viable for neurologically stable cases (ASIA D in this report). Critical conservative measures include: 1) Continuous neurological monitoring with surgical readiness; 2) Risk factor mitigation (BP stabilization, anticoagulant cessation); 3) Pharmacotherapy combining analgesics, osmotic agents (mannitol), corticosteroids, and neurotrophins, despite ongoing debates regarding high-dose steroid protocols; 4) Adjunctive hyperbaric oxygen and rehabilitation therapies [ 11 ]. Our patient achieved complete recovery through strict bed rest, methylprednisolone (80mg IV), and multimodal therapy, demonstrating conservative potential in select cases. Diagnostic urgency mandates immediate MRI for suspected SSEH. Current evidence supports conservative trials for ASIA C-D cases, while ASIA A-B warrants prompt surgery. Nevertheless, hematoma resorption mechanisms and optimal conservative duration require further investigation to refine management protocols. This case underscores the necessity for individualized therapeutic strategies balancing neurological preservation against surgical risks. Declarations Authors’ contributions Menglong Jia and Shan Gao Co-first author and contributed equally to this work. All authors read and approved the final manuscript. Funding Not applicable. Availability of data and materials Not applicable. Ethics approval and consent to participate The case report has been approved for publication by the Research Ethics Committee of Weifang Hospital of Traditional Chinese Medicine. Consent for publication The patient has signed the consent. Competing interests The authors declare that they have no competing interests. References Chen Q, Zhong X, Liu W, Wong C, He Q, Chen Y. Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis. Eur Spine J. 2022;31(12):3274–85. 10.1007/s00586-022-07421-6 . Epub 2022 Oct 19. PMID: 36260132. Hsu CJ, Lin PZ, Ju DT, Hueng DY, Tseng KY. Prognostic Factors and Treatment Efficacy in Spontaneous Spinal Epidural Hematoma: A Single Center Experience and Literature Review. In Vivo. 2024 Sep-Oct;38(5):2415–2424. 10.21873/invivo.13710 . PMID: 39187334; PMCID: PMC11363805. Barwar N, Kumar N, Sharma A, Bharti A, Kumar R. A Rare Presentation of Spontaneous Spinal Epidural Hematoma as Spinal Cord Compression and Complete Paraplegia: A Case Report and Review of the Literature. Cureus. 2022;14(2):e22199. 10.7759/cureus.22199 . PMID: 35308734; PMCID: PMC8925991. Nakao S, Hirata H, Yoshihara T, Kobayashi T, Tsukamoto M, Egashira Y, Mawatari M, Morimoto T. Conservative management of spontaneous spinal epidural hematoma: A case report with favorable prognosis. Clin Case Rep. 2024;12(5):e8760. 10.1002/ccr3.8760 . PMID: 38686020; PMCID: PMC11056786. Groen RJ, Hoogland PV. High blood pressure and the spontaneous spinal epidural hematoma: the misconception about their correlation. Eur J Emerg Med. 2008;15(2):119–20. 10.1097/MEJ.0b013e328285d6e8 . PMID: 18446079. Figueroa J, DeVine JG. Spontaneous spinal epidural hematoma: literature review. J Spine Surg. 2017;3(1):58–63. 10.21037/jss.2017.02.04 . PMID: 28435919; PMCID: PMC5386890. Bakker NA, Veeger NJ, Vergeer RA, Groen RJ. Prognosis after spinal cord and cauda compression in spontaneous spinal epidural hematomas. Neurology. 2015;84(18):1894–903. 10.1212/WNL.0000000000001545 . Epub 2015 Apr 10. PMID: 25862799. Cheng J, Li B, Liu S, Liu Y, Zhao Y. Case report: a patient with spontaneous spinal epidural hematoma recovered after conservative treatment. Front Med (Lausanne). 2025;12:1509903. 10.3389/fmed.2025.1509903 . PMID: 39967594; PMCID: PMC11832481. Kahraman MA, Senturk S. The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review. Cureus. 2023;15(8):e44192. 10.7759/cureus.44192 . PMID: 37641725; PMCID: PMC10460501. Wu ZY, Zhu YJ, Chu L, Cheng CY, Chen CM, Hui-Ting H. World Neurosurg. 2017;98. 10.1016/j.wneu.2016.07.086 . Epub 2016 Aug 2. PMID: 27495842. :883.e13-883.e20. Kim T, Lee CH, Hyun SJ, Yoon SH, Kim KJ, Kim HJ. Clinical Outcomes of Spontaneous Spinal Epidural Hematoma: A Comparative Study between Conservative and Surgical Treatment. J Korean Neurosurg Soc. 2012;52(6):523–7. 10.3340/jkns.2012.52.6.523 . Epub 2012 Dec 31. PMID: 23346323; PMCID: PMC3550419. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Dec, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted Editorial decision: Revision requested 18 Nov, 2025 Reviews received at journal 17 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviews received at journal 07 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers invited by journal 03 Nov, 2025 Editor assigned by journal 03 Nov, 2025 Submission checks completed at journal 03 Nov, 2025 First submitted to journal 25 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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08:49:11\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":60508,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eLumbar computer tomography imaging without contrast, arrow: epidural hematoma at the T12-L1 levels occupies the spinal canal and compresses the spinal cord.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7944394/v1/29a1614961d0637c7ef896d6.jpeg\"},{\"id\":95808108,\"identity\":\"a26a0477-fbf7-4428-900a-9c0fdceb1fdb\",\"added_by\":\"auto\",\"created_at\":\"2025-11-13 08:49:19\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":205716,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eLumbal magnetic resonance imaging without contrast, arrow: epidural hematoma occupies the spinal canal and compresses the spinal 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The previously observed epidural hematoma has now completely resolved.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage4.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7944394/v1/2e71b3e83e383eed4ad35fda.jpeg\"},{\"id\":98815058,\"identity\":\"6d6c9591-adde-45a8-8679-4a8c06c1839e\",\"added_by\":\"auto\",\"created_at\":\"2025-12-22 16:13:20\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1015189,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7944394/v1/40f615d6-8cfc-44fa-8512-565dc1267639.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Conservative management of spontaneous thoracolumbar epidural hematoma: a case report\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eSpinal epidural hematoma (SEH), classically considered a well-documented complication of spinal procedures, primarily results from inadequate intraoperative hemostasis or compromised postoperative drainage [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. In contrast, spontaneous spinal epidural hematoma (SSEH) represents a rare clinical entity with an estimated annual incidence of 0.1 per 100,000 individuals, characterized by idiopathic onset and poorly understood pathophysiological mechanisms [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Typical manifestations include acute-onset cervicodorsal or lumbosacral pain accompanied by rapidly progressive neurological deficits secondary to spinal cord compression. This condition's non-specific presentation often leads to significant diagnostic challenges. The clinical manifestations can easily confound attending physicians, as similar symptoms may also present in other clinical entities, including but not limited to cerebrovascular accidents, myocardial infarction, and meningitis, potentially leading to irreversible neurological sequelae when therapeutic intervention is delayed. Current management paradigms prioritize surgical decompression as the gold-standard intervention for SSEH [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e], with limited literature documenting successful non-surgical management. Notably, we present a case of spontaneous thoracolumbar epidural hematoma (T10-L1 distribution) that achieved complete clinical resolution through conservative measures. The patient demonstrated full neurological recovery (ASIA Impairment Scale improvement from Grade C to E) and radiological hematoma clearance within a 20-day observation period, as confirmed by serial MRI examinations. This case highlights the potential viability of watchful waiting protocols in select SSEH presentations, particularly when surgical contraindications exist or in resource-limited settings. Our findings urge spinal specialists to consider individualized therapeutic strategies while advocating for further investigations to establish evidence-based selection criteria for non-operative management.\\u003c/p\\u003e\"},{\"header\":\"Case presentation\",\"content\":\"\\u003cp\\u003eA 59-year-old man with a history of hypertension and a long-term habit of smoking and drinking presented with acute thoracolumbar pain accompanied by lower limb weakness. These symptoms occurred when he was doing morning activities 30 minutes ago, and then he was transported to the emergency department by ambulance. The pain intensity reached a significant score of 8 on the Visual Analogue Scale (VAS) (with a full score of 10). Imaging revealed a 5.7 cm non-enhancing extradural hematoma at T11-L1 causing spinal canal stenosis and conus medullaris compression, with laboratory findings showing mild erythrocytopenia (4.19\\u0026times;10\\u0026sup1;\\u0026sup2;/L) and normal coagulation profile. Despite presenting with significant neurological impairment (right/left lower limb muscle strength grades 4/3), conservative management was initiated due to stable neurological status, involving strict bed rest, methylprednisolone (80mg IV), mannitol, sodium aescinate, and adjunctive traditional Chinese medicine hot compresses. Remarkable recovery ensued: pain subsided within 24 hours (VAS 4\\u0026rarr;0), ambulation restored by day 6, and complete neurological recovery (ASIA Grade D\\u0026rarr;E) with hematoma resolution on 20-day follow-up MRI. This case demonstrates that select spontaneous spinal epidural hematomas without neurological progression may achieve full recovery through monitored conservative protocols combining anti-edema therapy, neuroprotection, and physical rehabilitation, challenging the traditional surgical imperative while underscoring the importance of individualized neurological surveillance in non-operative management.\\u003c/p\\u003e\"},{\"header\":\"Discussion and conclusions\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003cp\\u003eSpontaneous spinal epidural hematoma (SSEH) predominantly affects middle-aged and elderly populations with a slight male predominance. Current evidence suggests multifactorial etiologies including hypertension, coagulation disorders, anticoagulant use, and arteriovenous malformations, though the precise pathomechanisms remain elusive [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. The presented case involved a hypertensive patient with irregular medication adherence (admission BP: 190/110 mmHg), yet Groen et al. [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e] demonstrated no statistical correlation between hypertension prevalence in SSEH cohorts versus controls, suggesting acute pain-induced blood pressure elevation might better explain such observations. Hemorrhagic origins remain debated: arterial rupture typically manifests rapid neurological deterioration, while venous bleeding often stabilizes early [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Bakker et al. [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e] anatomically favors venous sources, particularly emphasizing posterior vertebral plexus prominence in lower thoracic regions of elderly patients\\u0026mdash;consistent with our case's non-progressive neurological deficits indicative of venous origin.\\u003c/p\\u003e\\u003cp\\u003eSSEH typically presents with acute axial pain accompanied by sensorimotor deficits in clinical settings, necessitating comprehensive differential diagnosis from conditions like intracranial lesions and aortic dissection. Although clinical manifestations may provide preliminary diagnostic clues, imaging modalities such as CT or MRI remain indispensable for definitive confirmation, underscoring their pivotal role as the gold standard in clinical decision-making [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. MRI remains diagnostic gold standard, demonstrating longitudinal epidural masses; emergency CT may reveal hyperdense lesions from hemosiderin deposition, as observed in this patient (T11-L1 hyperdensity) accompanied by mild erythrocytopenia (4.19\\u0026times;10\\u0026sup1;\\u0026sup2;/L), collectively supporting acute hematoma formation. Contrast-enhanced MRI further confirmed non-enhancing lesions, excluding vascular malformations.\\u003c/p\\u003e\\u003cp\\u003eTherapeutic consensus prioritizes surgical decompression within 48 hours via traditional laminectomy or emerging endoscopic techniques [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. However, conservative management proves viable for neurologically stable cases (ASIA D in this report). Critical conservative measures include: 1) Continuous neurological monitoring with surgical readiness; 2) Risk factor mitigation (BP stabilization, anticoagulant cessation); 3) Pharmacotherapy combining analgesics, osmotic agents (mannitol), corticosteroids, and neurotrophins, despite ongoing debates regarding high-dose steroid protocols; 4) Adjunctive hyperbaric oxygen and rehabilitation therapies [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Our patient achieved complete recovery through strict bed rest, methylprednisolone (80mg IV), and multimodal therapy, demonstrating conservative potential in select cases.\\u003c/p\\u003e\\u003cp\\u003eDiagnostic urgency mandates immediate MRI for suspected SSEH. Current evidence supports conservative trials for ASIA C-D cases, while ASIA A-B warrants prompt surgery. Nevertheless, hematoma resorption mechanisms and optimal conservative duration require further investigation to refine management protocols. This case underscores the necessity for individualized therapeutic strategies balancing neurological preservation against surgical risks.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMenglong Jia and Shan Gao Co-first author and contributed equally to this work. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe case report has been approved for publication by the Research Ethics Committee of Weifang Hospital of Traditional Chinese Medicine.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe patient has signed the consent.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eChen Q, Zhong X, Liu W, Wong C, He Q, Chen Y. Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis. Eur Spine J. 2022;31(12):3274\\u0026ndash;85. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s00586-022-07421-6\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00586-022-07421-6\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Epub 2022 Oct 19. PMID: 36260132.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHsu CJ, Lin PZ, Ju DT, Hueng DY, Tseng KY. Prognostic Factors and Treatment Efficacy in Spontaneous Spinal Epidural Hematoma: A Single Center Experience and Literature Review. 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PMID: 39967594; PMCID: PMC11832481.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKahraman MA, Senturk S. The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review. Cureus. 2023;15(8):e44192. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.7759/cureus.44192\\u003c/span\\u003e\\u003cspan address=\\\"10.7759/cureus.44192\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. PMID: 37641725; PMCID: PMC10460501.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWu ZY, Zhu YJ, Chu L, Cheng CY, Chen CM, Hui-Ting H. World Neurosurg. 2017;98. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.wneu.2016.07.086\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.wneu.2016.07.086\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Epub 2016 Aug 2. PMID: 27495842. :883.e13-883.e20.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKim T, Lee CH, Hyun SJ, Yoon SH, Kim KJ, Kim HJ. Clinical Outcomes of Spontaneous Spinal Epidural Hematoma: A Comparative Study between Conservative and Surgical Treatment. J Korean Neurosurg Soc. 2012;52(6):523\\u0026ndash;7. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3340/jkns.2012.52.6.523\\u003c/span\\u003e\\u003cspan address=\\\"10.3340/jkns.2012.52.6.523\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Epub 2012 Dec 31. PMID: 23346323; PMCID: PMC3550419.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"international-journal-of-emergency-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ijem\",\"sideBox\":\"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)\",\"snPcode\":\"12245\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12245/3\",\"title\":\"International Journal of Emergency Medicine\",\"twitterHandle\":\"@IntJEmergMed\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Spontaneous Spinal Epidural Hematoma, Spontaneous Absorption, Non-surgical Treatment\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7944394/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7944394/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSpontaneous spinal epidural hematoma (SSEH) is an exceedingly rare clinical entity often associated with neurological deficits, for which surgical intervention remains the mainstay of treatment. We report a novel case successfully managed through complete conservative therapy.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCase Presentation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA 59-year-old Chinese male with a medical history of hypertension, chronic smoking, and alcohol use presented to our institution with acute-onset low back pain accompanied by bilateral lower limb weakness and hypoesthesia persisting for 30 minutes. Diagnostic imaging (CT and MRI) revealed a thoracolumbar epidural hematoma (T11-L1 distribution). Contrary to conventional management paradigms, we implemented a comprehensive conservative management protoco. Remarkably, complete resolution of symptoms and spontaneous hematoma absorption were achieved within 20 days.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis case demonstrates that select SSEH cases may achieve favorable outcomes through conservative management without surgical decompression.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Conservative management of spontaneous thoracolumbar epidural hematoma: a case report\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-13 08:17:40\",\"doi\":\"10.21203/rs.3.rs-7944394/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-11-18T13:42:43+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-17T05:44:28+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"230763703185806478055235970174432306676\",\"date\":\"2025-11-10T11:58:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-07T09:39:39+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"158467766223422962797184680813705781968\",\"date\":\"2025-11-04T01:32:01+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-11-03T21:45:35+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-03T05:07:10+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-11-03T05:06:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"International Journal of Emergency Medicine\",\"date\":\"2025-10-25T04:38:32+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"international-journal-of-emergency-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ijem\",\"sideBox\":\"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)\",\"snPcode\":\"12245\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12245/3\",\"title\":\"International Journal of Emergency Medicine\",\"twitterHandle\":\"@IntJEmergMed\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"6f9ce36e-5516-4f49-8f55-375ae3dc5684\",\"owner\":[],\"postedDate\":\"November 13th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-22T16:09:30+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7944394\",\"link\":\"https://doi.org/10.1186/s12245-025-01105-w\",\"journal\":{\"identity\":\"international-journal-of-emergency-medicine\",\"isVorOnly\":false,\"title\":\"International Journal of Emergency Medicine\"},\"publishedOn\":\"2025-12-16 15:58:16\",\"publishedOnDateReadable\":\"December 16th, 2025\"},\"versionCreatedAt\":\"2025-11-13 08:17:40\",\"video\":\"\",\"vorDoi\":\"10.1186/s12245-025-01105-w\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12245-025-01105-w\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7944394\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7944394\",\"identity\":\"rs-7944394\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}