요추 추간판 탈출증과 유사한 자발성 경막외 혈종

Spontaneous Lumbar Epidural Hematoma Mimicking Lumbar Disc Herniation

Objective : Spontaneous lumbar epidural hematoma is a rare entity, although the precipitating factors such as anticoagulation therapy frequently precede it. The authors report four cases of surgically confirmed spontaneous epidural hematoma mimicking lumbar disc herniation. Methods : Between 1995 and 1998, four patients with spontaneous lumbar epidural hematoma were diagnosed. The clinical findings which are identical to that of acute disc herniation are included in this study. The operative findings and radiological characteristics are also included. Results : The magnetic resonance(MR) image findings demonstrated epidural lesions of intermediate to low signal intensity equivalent to those of normal discs on $T_1$-weighted images, and epidural lesions of high signal intensity higher than these normal discs on a $T_2$-weighted image. The image findings also showed rim enhanced pattern of the gadolinium-enhanced $T_1$-weighted MR images. All of the hematomas was associated with a small concomitant disc herniation or underlying annular tear. Conclusion : The authors speculate that spontaneous lumbar epidural hematoma results from tearing of the fragile penetrating vein caused by underlying disc or annulus disruption between Batson' plexus and vertebral body.