Conservative Treatment for Spontaneous Resolution of Postoperative Symptomatic Thoracic Spinal Epidural Hematoma-A Case Report.

Introduction: Postoperative epidural hematomas of the cervical and thoracic spine can pose a great risk of rapid neurological impairment and sometimes require immediate decompressive surgery. Case Report: We present the case of a young patient operated on for stabilization of a two-level thoracic vertebra fracture who developed total paralysis due to an epidural hematoma postoperatively. The course of epidural hematoma was quickly reversed with the help of a conservative technique that prevented revision surgery. The patient regained complete neurologic function very rapidly, and has been well on every follow-up to date. Conclusion: There is a role of similar maneuvers as described in this case to be employed in the management of postoperative epidural hematomas. However, prolonged watchful waiting should still be discouraged, and patients should remain ready for revision surgery if there are no early signs of rapid recovery.

Arthroscopic removal of arch-shaped rotator cuff calcifying tendinitis without rotator cuff repair and acromioplasty is an excellent treatment regarding pain relief and function.

PURPOSE: The aim of this study is to evaluate clinical outcome for arthroscopic removal of calcium deposit without acromioplasty and rotator cuff repair for patients with ultrasound-diagnosed arch-shaped calcifying tendinitis of the rotator cuff (type I), homogenic (x-ray) with chronic pain. METHODS: We retrospectively reviewed 50 patients with homogenous, arch-shaped calcifying tendinitis, suffering from chronic pain and who underwent arthroscopic treatment and 50 patients with the same type of tendinitis treated conservatively. All patients had calcium deposit located in supraspinatus tendon, pre-operatively and post-operatively evaluated by ultrasound. Clinical outcome was assessed by using Quick DASH, UCLA, and VAS score. RESULTS: There were 29 male and 71 female patients; none had bilateral involvement. We divided patients into group A-operatively treated-and group B-conservatively treated-by shock wave therapy. Patients from group A had higher improvement of all used tests, QDash (from 19.3 to 2.7), UCLA (from 10 to 34), and VAS score (from 3 to 0) when compared with group B. CONCLUSION: Patients with arch-shaped calcium deposits and acoustic shadow have better results after arthroscopic treatment than the conservative one. There was no need for acromioplasty or tendon repair. The lack of performing the same did not have any impact on the post-operative rehabilitation and recovery.