Although the etiology of spontaneous
spinal epidural hematoma (SSEH) is unclear, SSEH is known to be associated with
anticoagulants, coagulopathy,
vascular malformation,
hypertension, and pregnancy. However, no report has been issued on the relation between SSEH and venous phlebolith. Here, the authors present an extremely rare case of SSEH associated with phlebolith in the cervical spine and suggest a possible pathogenesis. A 36-year-old man without any relevant medical history presented with
neck pain and
numbness and severe
radiating pain on the left arm. Magnetic resonance imaging showed epidural
hematoma at the C5-7 level, and computed tomography revealed a calcified nodule in the left epidural
hemorrhage at C6 level. During left partial
laminectomy, epidural venous plexus, and thick epidural
hematoma were found, and
hematoma removal revealed a white, ovoid, smooth, hard mass of diameter 3 mm. Histopathologic examination confirmed the mass as a venous phlebolith. The presence of a calcified solitary nodule in dorsal epidural space indicates the presence of phlebolith and the risk of SSEH. In such cases, the authors recommend spine surgeons should take into consideration the possibility of epidural
hemorrhage.