There is a debate over the origin of bleeding in case of spontaneous spinal epidural hematoma (SSEH). The most widely accepted theory is of venous origin. Since the epidural veins are valveless, there will be increased venous pressure transmitted from intrathoracic and intraabdominal compartments on straining, causing rupture. Another view is that only arterial bleeding can cause rapid compression of spinal cord, since the venous pressure is less than intrathecal pressure. There is a lack of consensus on treatment also. Most of the authors recommend urgent decompressive laminectomy. There is a recent trend towards less invasive options such as partial laminectomy and hemilaminectomy and conservative treatment. Aim of this study is to review the theories about the origin of bleeding in spontaneous spinal epidural hematoma and the methods of treatment. Literature search was done in PubMed for theories of the origin of spontaneous spinal epidural hematoma and the treatment methods. Descriptive analysis was done. A 49-year-old male stoneworker presented with thoracic back pain of acute onset while doing work, followed by weakness of forearm and legs. He had paraplegia with grade 1 power of lower limbs. MRI showed posterior epidural hematoma from C3 to T4. Midline partial laminectomy was done from C5 to T2. Hematoma was evacuated. His power improved over 1 week. Later CT (computed tomography) angiography showed no vascular malformation. Cervical location and rapid development of weakness point towards arterial origin of spontaneous spinal epidural hematoma. Thoracic location and presence of peroperative venous ooze suggest venous origin. Partial or hemilaminectomy is recommended to reduce postoperative instability. Conservative treatment is preferred in case of coagulopathy.

中文翻译：

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特发性脊柱硬膜外血肿背景下自发性脊柱硬膜外血肿文献综述

关于自发性脊柱硬膜外血肿（SSEH）出血的起源尚有争议。最广泛接受的理论是静脉起源的。由于硬膜外静脉是无瓣膜的，因此在拉伸时会从胸腔和腹腔传递的静脉压力增加，从而导致破裂。另一观点是，由于静脉压力小于鞘内压力，因此仅动脉出血可引起脊髓快速压迫。在治疗上也缺乏共识。大多数作者建议紧急减压椎板切除术。近来，趋向于侵入性较小的选择，例如部分椎板切除术和半椎板切除术以及保守治疗。这项研究的目的是回顾有关自发性脊髓硬膜外血肿出血起源的理论和治疗方法。在PubMed中进行了文献搜索，以了解自发性脊髓硬膜外血肿的起源和治疗方法。描述性分析已经完成。一名49岁的男性石工在工作时出现急性发作的胸背痛，随后是前臂和腿无力。他患有下肢1级力量截瘫。MRI显示C3至T4后硬膜外血肿。从C5到T2进行中线部分椎板切除术。血肿被疏散。他的力量在1周内得到了改善。后来的CT（计算机断层扫描）血管造影未显示血管畸形。颈椎位置和无力的快速发展指向自发性脊髓硬膜外血肿的动脉起源。胸腔位置和术中静脉渗液的存在提示静脉起源。建议进行部分或半椎板切除术以减少术后不稳定。在凝血病的情况下，首选保守治疗。