Spinal epidural hematoma after spinal manipulation therapy: Report of three cases and a literature review

Figure 1 Imaging examinations of case 1. A: T1-weighted preoperative magnetic resonance imaging (MRI) image shows high signal intensity (orange arrow); B and C: Preoperative T2-weighted image shows low signal intensity, and an axial T2-weighted image demonstrates that the hematoma occurred in the posterior region (white arrow); D: Preoperative enhanced MRI suggests an enhanced hematoma signal (orange arrow); E: Intraoperative photograph shows that spinal cord compression has recovered; F: Postoperative pathology suggested a hematoma; G and H: X-ray at the 3-mo follow-up indicated intact internal fixation.

Figure 2 Imaging examinations of case 2. A-C: First emergency magnetic resonance imaging (MRI) images. T1- and T2-weighted images of the thoracic spine show low-intensity spinal epidural hematoma at T1–3; an axial T2-weighted image demonstrates that the hematoma was in the posterior region (white arrow); D-F: The hematoma still existed but was slightly reduced after conservative treatment compared with admission (arrow); G and H: Postoperative review showing good internal fixation; I: Postoperative pathology suggested a hematoma.

Figure 3 Imaging examinations of case 3. A: First emergency magnetic resonance imaging (MRI) scan. T1-weighted image of the thoracic spine shows isometric-intensity spinal epidural hematoma at T1–2 (white arrow); B and C: First emergency MRI scans. T2-weighted image shows high signal intensity; axial T2-weighted image shows that the hematoma was in the posterolateral region (white arrow); D: Preoperative MRI suggests an enhanced hematoma signal (orange arrow); E: The hematoma decreased in size after conservative treatment (white arrow); F-H: After 72 h of conservative treatment, MRI showed that the hematoma worsened again (white arrow); I: The hematoma completely disappeared at the 3-mo follow-up (white arrow).