An Atypical Mechanism of Injury Leading to Posterior Spinal Cord Compression from Epidural Hematoma: A Case Report

Case Diagnosis: Thoracic epidural hematoma

Case Description or Program Description: A 31-year-old male with no past medical history presented to the emergency department four days after a skiing trip in Vermont. He recalled only one fall during the trip, in which he slipped on a patch of ice and landed gently in a seated position. Otherwise, he skied without incident. Approximately four days after returning home, he developed back spasms. The pain subsided overnight, and he proceeded to work the following day. However, he then began experiencing muscle spasms in his lower extremities, which progressed to bilateral lower extremity weakness and difficulty urinating. These symptoms ultimately prompted his visit to the emergency department. On examination, the patient had bilateral lower extremity weakness with intact rectal tone. Due to urinary retention, straight catheterization was required.

Setting: Acute inpatient rehabilitation

Assessment/Results: MRI of the thoracic spine showed a large T9-T10 dorsal epidural hematoma, with severe cord compression. Neurosurgery emergently took the patient to the operating room for T9-T10 laminectomy with decompression. Given the mechanism of injury, hematology was consulted for possible coagulopathy. Work up was negative.

Discussion (relevance): This is the first reported case, to our knowledge, of this mechanism of injury regarding epidural hematoma from sudden, but low-impact axial loading causing delayed thoracic epidural hematoma and subsequent posterior cord compression requiring surgical intervention.

Conclusions: This case highlights an unusual mechanism of injury leading to epidural hematoma and severe posterior spinal cord compression, emphasizing the need for heightened clinical suspicion even after seemingly minor trauma.