Does different operation timing for spontaneous cervical spinal epidural hematoma lead to different prognosis? A retrospective study of 36 cases

Background SCSEH ( Spontaneous cervical spinal epidural hematoma) is a rare yet serious clinical entity characterized by idiopathic, non-traumatic, and non-iatrogenic accumulation of blood in the cervical epidural space. For patients who experience sudden neck pain and nerve root pain symptoms, acute cervical spinal epidural hematoma should be regarded as a possible differential diagnosis cas.In recent years, such cases have been reported globally, yet treatment strategies remain heterogeneous with inconclusive efficacy evidence. While surgical decompression is widely advocated for optimal neurological recovery, conventional protocols lack specificity regarding optimal intervention timing.Over a 13-year period, we surgically managed 36 SCSEH cases. This study analyzes the intervals from symptom onset to hospital admission and admission to surgical intervention, with comparative assessment of postoperative neurological outcomes. Methods A retrospective study was conducted on 36 patients (23 males and 13 females; mean age 48.43 ± 2.17 years) diagnosed with SSCEH between January 2006 and January 2019. All patients presented with varying degrees of neurological deficits upon admission and underwent single-stage surgical intervention comprising cervical spinal canal decompression, epidural hematoma evacuation, and internal fixation. Patients were categorized based on the time interval from symptom onset to surgery.Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), and American Spinal Injury Association (ASIA) Impairment Scale. All patients achieved a minimum follow-up of 12 months (mean 16.4 ± 2.17 months). Radiographs, CT(computed tomography ), and MRI(magnetic resonance imaging ) were utilized to evaluate fusion status and spinal stability. Results All 36 patients exhibited statistically significant improvements (P < 0.05) in ASIA grade, VAS score, and JOA score at the final follow-up compared to preoperative assessments. Functional recovery was comparable between patients undergoing surgery within 8 hours of symptom onset and those operated between 8 and 24 hours post-onset, with no statistically significant difference in postoperative functional outcomes (p > 0.05). However, patients receiving surgical intervention within 24 hours demonstrated significantly superior functional recovery compared to those operated beyond 24 hours (P < 0.05). The postoperative follow-up imaging results indicated no rebleeding, no significant loss of cervical curvature, no collapse of the bone graft or no displacement of the implant, and good spinal canal volume. Conclusions Patients with SCSEH undergoing surgery within 8 hours of symptom onset demonstrated comparable postoperative functional recovery to those operated between 8–24 hours. However, subjects receiving intervention within 24 hours collectively showed superior functional outcomes compared to those undergoing surgery beyond 24 hours Trial registration: The studies involving humans were approved by the Ethics Committee of People's Hospital of Guangxi Zhuang Autonomous Regionl. The studies were conducted in accordance with the local legislation and institutional require ments. Written informed consent for participation was not required from the participants or the participants’ legal guardians/next of kin in accordance with the national legislation and institutional requirements.