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Case presentation A 70-year-old woman, 157-cm tall and weighing 40 kg, experienced acute back pain upon waking and called emergency medical services. Her medical history included only hypertension, for which she was taking 10-mg manidipine hydrochloride each morning and no anticoagulants. On presentation, her consciousness level was clear, blood pressure 176/93 mmHg, heart rate 120 beats/min, SpO2 100%, and respiratory rate 30 breaths/min. Abdominal ultrasonography did not indicate abnormal findings, and blood biochemical parameters, including coagulation tests, were normal. Although manual motor testing was difficult to perform because of the patient’s severe back pain, no obvious neurological deficits were confirmed. The patient’s pain numerical rating score was 9–10; therefore, we administered 600 mg of acetaminophen and inserted a 25-mg diclofenac suppository. Twenty hours after onset, her back pain had almost disappeared, but she had developed weakness in her lower extremities (Table 1) and sensory disorder in the lower umbilical region. We performed magnetic resonance imaging (MRI) immediately, which showed compression of the posterior aspect of the spinal cord by a hematoma extending from T10–L1 (Fig. 1). Emergency evacuation of the hematoma, T10–T12 total laminectomy, and L1 laminotomy were performed immediately. Her postoperative course was good, and she was discharged from the hospital 17 days postoperatively without complications.

ja clinical reports

Emergency operation for spontaneous spinal epidural hematoma in a patient with severe back pain, which made it difficult to evaluate neurological deficits: a case report