Spontaneous spinal epidural haematomas in children

  • S. Soltani
  • M. C. Nogaro
  • C. Rougelot
  • N. Newell
  • K. Lim
  • D. C. KieserEmail author
Review Article



To understand the typical presentation, risk factors, location and size, treatment, neurological recovery and survival of spontaneous spinal epidural haematomas (SSEH) in children.


A systematic review of the English literature from 1 January 1960 to 1 March 2018 was performed on children aged 18 years and younger. Individual patient data were extracted and collated. Outcome measures were mode of presentation, risk factors, initial neurological findings, initial presumed diagnosis, diagnostic investigations, site and size of the SSEH, treatment, neurological recovery and survival.


Thirty-one publications and 36 patients were reviewed. All age groups were affected. 83% of patients did not have a known risk factor. Back pain was reported in 61% and neurological dysfunction in 97% of patients, although not all articles defined these parameters. Initially 28% of patients were suspected of having an alternative diagnosis. All patients had an MRI and/or CT scan confirming the diagnosis. The cervical-thoracic region was most commonly affected, and the average haematoma size extended across 6.3 vertebral levels. Surgical decompression was performed in 72% of patients. Neurological function improved in 83% of patients. Two patients died as a consequence of their SSEH.


SSEHs affect all paediatric age groups and typically present with neurological dysfunction and/or back pain. The initial diagnosis is incorrect in up to 28% of cases, but cross-sectional spinal imaging is diagnostic. Most SSEHs are located in the cervico-thoracic region and affect multiple spinal levels. The treatment depends on whether the patient has a bleeding disorder and their neurological status.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Spontaneous Epidural Haematoma Spine SEH 



The authors thank Glynny Kieser for her editorial input.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Supplementary material

586_2019_5975_MOESM1_ESM.pptx (172 kb)
Supplementary material 1 (PPTX 172 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Spinal SurgeryOxford University NHS Foundation TrustOxfordUK
  2. 2.Paediatric DepartmentOxford University NHS Foundation TrustOxfordUK
  3. 3.Department of Mechanical EngineeringImperial CollegeLondonUK
  4. 4.Department of Orthopaedics and Musculoskeletal Medicine, Christchurch School of MedicineUniversity of OtagoChristchurchNew Zealand

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