{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T08:07:39Z","timestamp":1758701259893,"version":"3.44.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background and importance<\/jats:title><jats:p>Spinal cord hemorrhage (SCH), particularly involving the bulbar-cervical segment (medulla oblongata to C7), is a rare and life-threatening neurological emergency. Due to its anatomical proximity to respiratory, motor, and sensory centers, it often leads to catastrophic neurological deficits. Etiologies include vascular malformations, coagulopathy, or idiopathic causes, yet its low incidence (&amp;lt;1%) poses significant challenges in early diagnosis and management. Current evidence highlights emergency hematoma evacuation, adequate decompression, and spinal stabilization as critical for improving prognosis, though clinical validation through case-based data remains limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 28-year-old male presented with acute dyspnea, limb numbness, and progressive weakness (left 1\/5, right 2\/5 on the Medical Research Council scale) over 2\u2005h. Neurological examination revealed a sensory deficit below the T4 dermatome and bilateral pyramidal signs. Imaging confirmed a hematoma extending from the medulla oblongata to C7, with no evidence of vascular malformations or trauma. Emergency microscopic hematoma evacuation (8\u2005ml) was performed, combined with posterior cervical double-door laminectomy (C3\u2013C7) and pre-contoured rod pedicle screw fixation. Postoperatively, mechanical ventilation was discontinued within 24\u2005h. Sensory levels regressed to T8, and motor function improved progressively (left 3+\/5, right 5\/5 at 2-month follow-up). Postoperative imaging confirmed complete hematoma resolution and stable instrumentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Bulbar-cervical SCH necessitates vigilant monitoring for cardiorespiratory compromise. Multidisciplinary emergency intervention\u2014hematoma evacuation with decompression\u2014effectively halts neurological deterioration. The dual-door laminectomy technique optimizes spinal canal expansion while preserving stability, providing a biomechanical foundation for neural recovery. This case underscores the pivotal role of early surgical decompression and stabilization in achieving favorable long-term outcomes for high-level SCH.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1622953","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T05:34:49Z","timestamp":1755149689000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergency surgical intervention for bulbar-cervical spinal cord hemorrhage: a case report and review of management strategies"],"prefix":"10.3389","volume":"12","author":[{"given":"Chuan","family":"He","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Cao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.nbd.2014.05.022","article-title":"Activation of Akt\/FKHR in the medulla oblongata contributes to spontaneous respiratory recovery after incomplete spinal cord injury in adult rats","volume":"69","author":"Felix","year":"2014","journal-title":"Neurobiol Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3171\/2014.3.PEDS13565","article-title":"Thoracolumbar spinal vascular malformation as a rare cause of isolated intraventricular hemorrhage","volume":"14","author":"Marlin","year":"2014","journal-title":"J Neurosurg Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1038\/s41394-024-00693-8","article-title":"Spontaneous spinal epidural hematomas-time is running out!","volume":"10","author":"Raju","year":"2024","journal-title":"Spinal Cord Ser Cases"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e32037","DOI":"10.1371\/journal.pone.0032037","article-title":"Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in acute spinal cord injury study (STASCIS)","volume":"7","author":"Fehlings","year":"2012","journal-title":"PLoS One"},{"key":"B5","doi-asserted-by":"publisher","first-page":"E401","DOI":"10.1093\/neuros\/nyz156","article-title":"In reply: ultra-early (<12 hours) surgery correlates with higher rate of American Spinal Injury Association impairment scale conversion after cervical spinal cord injury","volume":"85","author":"Burke","year":"2019","journal-title":"Neurosurgery"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.22037\/aaem.v10i1.1471","article-title":"Ultra-early spinal decompression surgery can improve neurological outcome of complete cervical spinal cord injury; a systematic review and meta-analysis","volume":"10","author":"Yousefifard","year":"2022","journal-title":"Arch Acad Emerg Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1089\/neu.2014.3767","article-title":"Neurological recovery after traumatic cervical spinal cord injury is superior if surgical decompression and instrumented fusion are performed within 8 hours versus 8 to 24 hours after injury: a single center experience","volume":"32","author":"Jug","year":"2015","journal-title":"J Neurotrauma"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1089\/neu.2015.4325","article-title":"Early decompression (<8\u2009h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year","volume":"33","author":"Grassner","year":"2016","journal-title":"J Neurotrauma"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e311","DOI":"10.3928\/01477447-20200521-06","article-title":"Surgical outcomes in selective laminectomy and conventional double-door laminoplasty for cervical spondylotic myelopathy","volume":"43","author":"Yoshii","year":"2020","journal-title":"Orthopedics"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e362","DOI":"10.1016\/j.wneu.2017.11.017","article-title":"Posterior cervical laminectomy results in better radiographic decompression of spinal cord compared with anterior cervical discectomy and fusion","volume":"110","author":"Piazza","year":"2018","journal-title":"World Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2831","DOI":"10.1007\/s00586-020-06563-9","article-title":"Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance","volume":"29","author":"Pan","year":"2020","journal-title":"Eur Spine J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e13534","DOI":"10.1097\/MD.0000000000013534","article-title":"Comparison of anchor screw fixation versus mini-plate fixation in unilateral expansive open-door laminoplasty for the treatment of multi-level cervical spondylotic myelopathy","volume":"97","author":"Lin","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"257","DOI":"10.5137\/1019-5149.JTN.20007-17.1","article-title":"Open-door laminoplasty with preservation of muscle attachments of C2 and C7 for cervical spondylotic myelopathy: retrospective study","volume":"28","author":"Secer","year":"2018","journal-title":"Turk Neurosurg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1622953\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T05:34:50Z","timestamp":1755149690000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1622953\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":13,"alternative-id":["10.3389\/fsurg.2025.1622953"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1622953","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]},"article-number":"1622953"}}