{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T09:45:24Z","timestamp":1774863924337,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Spontaneous spinal subdural hematoma (SSSDH) is a rare and severe condition that causes rapid neurological decline. Spontaneous spinal epidural hematoma (SSEH) presents similarly but is more common, and surgical management differs because SSSDH requires an intradural approach. Few studies have assessed the reliability of magnetic resonance imaging (MRI) features used to distinguish SSSDH from SSEH in patients requiring surgery. Methods: We retrospectively reviewed 27 patients who underwent surgical evacuation of spinal hematomas at two institutions (2015\u20132025). Definitive hematoma location was determined intraoperatively. Four MRI features\u2014shape (crescentic vs. biconvex), location (ventral vs. dorsal), craniocaudal length (&lt;5 vs. \u22655 segments), and spinal region\u2014were independently evaluated by two reviewers. Inter- and intra-rater reliability was assessed using agreement rate and Cohen\u2019s kappa (\u03ba) with 95% confidence intervals (95% CIs). Results: Among 27 cases, three (11.1%) were SSSDH and 24 were SSEH. Hematoma location, length, and spinal region demonstrated perfect inter- and intra-rater agreement (\u03ba = 1.00). For hematoma shape, intra-rater agreement was good (96.2%, \u03ba = 0.84; 95% CI 0.52\u20131.00), whereas inter-rater agreement was poor to fair (84.6%, \u03ba = 0.26; 95% CI \u22120.25\u20130.77). Notably, two of the three SSSDHs demonstrated a biconvex configuration, and 83.3% of SSEHs also exhibited a biconvex morphology. Conclusions: MRI features such as hematoma location, extent, and spinal level were highly reproducible, whereas hematoma shape showed limited reliability. Although ventral hematomas most strongly suggest SSSDH, atypical SSEH presentations occur. When dorsal exposure reveals no epidural hematoma, intradural exploration should be promptly considered.<\/jats:p>","DOI":"10.3390\/jcm15072602","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:22:36Z","timestamp":1774858956000},"page":"2602","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reliability of Preoperative MRI Findings for Differentiating Spontaneous Spinal Subdural and Epidural Hematomas: A Multi-Institutional Retrospective Study of 27 Surgically Treated Cases"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9614-5399","authenticated-orcid":false,"given":"Shun","family":"Okuwaki","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4209-6990","authenticated-orcid":false,"given":"Katsuya","family":"Nagashima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital, Mito Clinical Education and Training Center, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito 310-0015, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Asada","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takane","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Sunami","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Ogata","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-2077","authenticated-orcid":false,"given":"Kotaro","family":"Sakashita","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisanori","family":"Gamada","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kousei","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9426-7731","authenticated-orcid":false,"given":"Hiroshi","family":"Noguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital, Mito Clinical Education and Training Center, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito 310-0015, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Funayama","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masao","family":"Koda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Tatsumura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital, Mito Clinical Education and Training Center, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito 310-0015, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.jos.2022.07.008","article-title":"Acute nontraumatic spinal subarachnoid hematomas: A report of five cases and a systematic review of the 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