Study Design Case report and literature review. Objective Spinal
subdural hematomas are rare events that often progress with severe
neurologic deficits. Although there have been several case reports in the literature of spontaneous
spinal subdural hematomas in the setting of anticoagulation, antiplatelet
therapy, or coagulation disorders, the exact pathophysiology of such phenomena remains obscure. Methods We present the first report of a
subdural hematoma after a percutaneous
vertebroplasty and provide a comprehensive review on the anatomy of venous drainage of the vertebral bodies with emphasis on the possible effects of
venous congestion caused by cement obstruction. Results Because the
subdural hematoma occurred in the absence of major cement extravasation to the spinal canal and two levels above the site of the
vertebroplasty, we discuss the possible role of
venous congestion as the main etiologic factor leading to
rupture of the fragile, valveless radiculomedullary veins into the subdural space. Conclusions The reported case supports a possible new pathophysiological scheme for the development of
spinal subdural hematoma in which
venous congestion plays a pivotal etiologic role. The reported findings suggests that future anatomical and histologic studies investigating the response of the radiculomedullary veins to congestive venous
hypertension may shed new light into the pathophysiology of
spinal subdural hematomas.