Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma

C. P. Little, N. Patel, J. Nagaria, Ramesh Kumar Athi Kumar, J. Nanra, C. M. Bolger

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Spontaneous spinal subdural haematoma is a rare cause of spinal cord compression, usually confined to a few vertebral levels. When the haematoma extends over several spinal segments, surgical decompression is a major undertaking. Recombinant tissue plasminogen activator (rt-PA) has previously been used in a number of surgical procedures, but not in the setting of acute spinal subdural haematoma. A minimally invasive technique of decompression, using topical rt-PA, is presented in two patients with extensive spinal intradural haematoma. Two patients receiving long-term anticoagulation therapy presented with acute-onset back pain progressing to paraparesis. Magnetic resonance imaging of the spine demonstrated spinal subdural haematomas extending over 15 vertebral levels in one patient and 12 in the other. An angiography catheter was introduced into the subdural space through a limited laminectomy. Thrombolysis and evacuation of haematoma was then achieved by intermittent irrigation of the subdural space with rt-PA, followed by saline lavage. Postoperative imaging demonstrated satisfactory decompression in both patients. There was significant improvement of neurological function in one patient. Topical application of rt-PA for spinal subdural haematoma allows evacuation of the haematoma through a limited surgical exposure. Decompression of the subdural space by this minimally invasive technique may be advantageous over extensive surgery by minimising surgical exposure, reducing postoperative pain and risk of neuronal injury. This technique may be useful in patients presenting with compression extending over several vertebral levels or poor surgical candidates.

Original languageEnglish
Pages (from-to)380-383
Number of pages4
JournalEuropean Spine Journal
Volume13
Issue number4
Publication statusPublished - Jul 2004
Externally publishedYes

Fingerprint

Spinal Subdural Hematoma
Hematoma, Subdural, Acute
Tissue Plasminogen Activator
Subdural Space
Hematoma
Decompression
Paraparesis
Surgical Decompression
Spinal Cord Compression
Laminectomy
Therapeutic Irrigation
Back Pain
Postoperative Pain
Angiography
Spine
Catheters
Magnetic Resonance Imaging
Wounds and Injuries

Keywords

  • Anticoagulant therapy
  • Spontaneous spinal subdural haematoma
  • Topical rt-PA

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Little, C. P., Patel, N., Nagaria, J., Athi Kumar, R. K., Nanra, J., & Bolger, C. M. (2004). Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma. European Spine Journal, 13(4), 380-383.

Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma. / Little, C. P.; Patel, N.; Nagaria, J.; Athi Kumar, Ramesh Kumar; Nanra, J.; Bolger, C. M.

In: European Spine Journal, Vol. 13, No. 4, 07.2004, p. 380-383.

Research output: Contribution to journalArticle

Little, CP, Patel, N, Nagaria, J, Athi Kumar, RK, Nanra, J & Bolger, CM 2004, 'Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma', European Spine Journal, vol. 13, no. 4, pp. 380-383.
Little, C. P. ; Patel, N. ; Nagaria, J. ; Athi Kumar, Ramesh Kumar ; Nanra, J. ; Bolger, C. M. / Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma. In: European Spine Journal. 2004 ; Vol. 13, No. 4. pp. 380-383.
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