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Spontaneous thoracic spinal subarachnoid hemorrhage is rare, and thus no useful radiological findings for preoperative diagnosis have been reported. We experienced a patient with spontaneous thoracic spinal subarachnoid hemorrhage. A 37-year-old female presented with sudden-onset paraplegia and numbness in the trunk and bilateral lower extremities. The patient had no past history of trauma, lumbar puncture and bleeding disorder. T2-weighted sagittal magnetic resonance imaging (MRI) of the cervical and thoracic spines showed a mass occupied in the ventral space of spinal cord that was dorsally shifted. The mass extended from C6 to Th6 levels, with its largest size at Th2 level. Thoracic spine T2-weighted sagittal and axial MRI showed that the mass compressed spinal cord and was located in the intradural space. There was no spinal cord tumor and no spinal vascular malformation around the mass. Brain computed tomography (CT) showed a high-density area in the subarachnoid space, indicating the possibility of subarachnoid hemorrhage. Brain MRI showed no ruptured aneurysm. The patient was diagnosed as a spontaneous thoracic spinal subarachnoid hemorrhage and emergency surgery was selected. We performed right-side hemilaminectomy at Th1-Th6 and opened dura mater and arachnoid membrane. Hematoma was found in the ventral space of spinal cord and was removed. One year after surgery, numbness in the trunk and bilateral lower extremities had disappeared but paraplegia remained unchanged. Thoracic spine T2-weighted MRI confirmed no hematoma but showed a newly formed intradural cyst. Preoperative combination of brain CT and thoracic MRI is useful to diagnose thoracic spinal subarachnoid hemorrhage.

The incidence of lumbar spinal canal stenosis (LSCS) is increasing in Japan. Posterior lumbar decompression surgery, wide fenestration and laminectomy, for LSCS is a common treatment modality. Compared with posterior fusion surgery, posterior decompression surgery has been considered as less invasive. However, no reports regarding postoperative anemia following posterior decompression surgery have been published. In this retrospective study, we evaluated changes in hemoglobin values following wide fenestration in 80 patients with LSCS based on the number of operated levels, and also analyzed the differences between intraoperative and postoperative bleeding volume. Two patients required allogenic transfusion. The mean preoperative hemoglobin values were 13.6 g/dL and the mean postoperative minimum hemoglobin values were 11.2 g/dL. The mean hemoglobin values decreased by 1.8 g/dL in patients with one operated level (n = 15); 2.2 g/dL in those with two operated levels (n = 31); 2.6 g/dL in those with three operated levels (n = 23); and 3 g/dL in those with four operated levels (n = 11). The mean decrease in hemoglobin values was calculated as follows: 1.8 + 0.4 × (X - 1), where X was the number of operated levels. The mean intraoperative bleeding volume was 94 ml and the mean postoperative bleeding volume was 418 ml. Postoperative bleeding volume was significantly larger than intraoperative bleeding volume. Accordingly, postoperative hemoglobin values can be predicted in patients undergoing wide fenestration. Effective management of postoperative bleeding is necessary to prevent postoperative anemia.