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Ogbu I, Eltoukhy M, Tzerakis N. Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21347. [PMID: 35855089 PMCID: PMC9265190 DOI: 10.3171/case21347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The case report detailed an unusual presentation of an iatrogenic dorsal cord herniation at the level of the thoracic cord after insertion of an epidural catheter 8 months before presentation to the neurosurgical clinic. OBSERVATIONS Only 13 cases of iatrogenic dorsal cord herniation, most of which occurred after spinal surgery, have been described in the literature. This was the first case of a spinal cord hernia described after the insertion of an epidural catheter. In this case study, the authors described a 38-year-old man who presented with progressive lower limb weakness, sensory deficits, perianal numbness, and urinary/fecal incontinence. He was diagnosed with a spinal cord hernia that reherniated after an initial sandwich duroplasty repair. Definitive repair was made after his re-presentation using an expansile duroplasty. LESSONS In patients with previous spinal instrumentation who present with neurological symptoms, spinal cord herniation should be considered a likely differential despite its rarity. In this case, a simple duroplasty was insufficient to provide full resolution of symptoms and was associated with recurrence. Perhaps a combination of graft and expansile duroplasty may be used for repair, especially when associated with a tethered cord and in the presence of significant adhesions.
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Affiliation(s)
- Ikenna Ogbu
- Department of Neurosurgery, Royal Stoke University Hospital, University Hospitals of North Midlands (UHNM), Staffordshire, West Midlands, United Kingdom
| | - Mohamed Eltoukhy
- Department of Neurosurgery, Royal Stoke University Hospital, University Hospitals of North Midlands (UHNM), Staffordshire, West Midlands, United Kingdom
| | - Nikolaos Tzerakis
- Department of Neurosurgery, Royal Stoke University Hospital, University Hospitals of North Midlands (UHNM), Staffordshire, West Midlands, United Kingdom
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Nakashima H, Ishikawa Y, Kato F, Kanemura T, Shinjo R, Ando K, Kobayashi K, Ishiguro N, Imagama S. Postoperative iatrogenic spinal cord herniation: three case reports with a literature review. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:383-389. [PMID: 32581417 PMCID: PMC7276416 DOI: 10.18999/nagjms.82.2.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although a majority of spinal cord herniation reportedly occurs idiopathically, postoperative iatrogenic spinal cord herniation is rare. Therefore, the incidence rate, pathogenic mechanism, and clinical outcomes are not clear. We present three cases of postoperative iatrogenic spinal cord herniation and present a literature review. Our data base included 32253 patients who underwent spinal surgery, and among these patients, 3 showed postoperative spinal cord herniation. Postoperative spinal cord herniation was observed in a 55-year-old man and a 60-year-old man. Both these patients underwent cervical laminoplasty for degenerative cervical myelopathy; however, intraoperative dural tear was reported. They presented with severe quadriplegia and sensory disorders at 8 years and 2 months after initial surgery. The third case of postoperative spinal cord herniation was of a 47-year-old woman who underwent Th11/12 schwannoma resection. Her neurological symptoms did not improve after tumor resection, and MRI at 2 months after surgery revealed spinal cord herniation. All the 3 patients underwent spinal cord reduction surgery; one patient showed sufficient neurological improvement while 2 patients with cervical spinal cord herniation showed limited neurological improvement due to preoperative severe quadriplegia. Although postoperative iatrogenic spinal cord herniation is a relatively rare pathology, careful observation with postoperative MRI is required in cases of patients with new neurological symptoms after dural injury and durotomy.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Yoshimoto Ishikawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Ryuichi Shinjo
- Department of Spine & Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kaliya-Perumal AK, Tan M, Nolan CP, Oh JYL. Post-surgical thoracic spinal cord herniation following an unrepaired dural defect: a rare complication. Br J Neurosurg 2019:1-4. [PMID: 31502478 DOI: 10.1080/02688697.2019.1661966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Surgery for ossification of the ligamentum flavum (OLF) comes with a relatively high risk of dural tear. We report a 50-year-old woman, who presented with symptomatic spinal stenosis from OLF at T11-T12 and lower lumbar spondylosis for which a single stage posterior decompression and instrumented fusion of both sites was done. Removal of the OLF resulted in a small dural tear with intact arachanoid which was covered using a fibrin sealant. In the first post-operative day, the patient's neurology started deteriorating. An MR scan was done to look for hematoma. It showed the spinal cord herniating out of the thecal sac at the operated level. Emergency re-operation was done to reduce the herniation and the dural defect was repaired. The patient gradually recovered to her best functional status. Based on this experience, we advise primary repair of inadvertent durotomies.
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Affiliation(s)
| | - Mark Tan
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital , Singapore
| | | | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital , Singapore
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Kharat A, Maheshwari S, Choudhury P, Mohapatra A. Double trouble!!! An unusual presentation of cervical cord herniation and medial end clavicle non-union in a single patient. BMJ Case Rep 2018; 2018:bcr-2018-224393. [PMID: 29669773 DOI: 10.1136/bcr-2018-224393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-union of medial end clavicle is rare. Though traditionally they have been treated with conservative methods, surgery at initial presentation should be considered in these patients since conservative treatment can lead to non-union. Herniation of spinal cord, though rare, is seen in the thoracic region but can also occur in the cervical region post-traumatically as seen in our patient.
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Affiliation(s)
- Amit Kharat
- Department of Radiology, Dr D. Y. Patil Vidyapeeth, Pimpri, Maharashtra, India
| | - Sagar Maheshwari
- Department of Radiology, Dr D. Y. Patil Vidyapeeth, Pimpri, Maharashtra, India
| | - Priyam Choudhury
- Department of Radiology, Dr D. Y. Patil Medical College and Hospital, Dr D. Y. Patil Vidyapeeth, Pimpri, Maharashtra, India
| | - Ashutosh Mohapatra
- Department of Orthopaedics, Mohapatra Hospital, Ulhasnagar,Mumbai, Maharashtra, India
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Heller RS, Hwang SW, Riesenburger RI. Dorsal Cervical Spinal Cord Herniation Precipitated by Kyphosis Deformity Correction for Spinal Cord Tethering. World Neurosurg 2017; 100:709.e1-709.e4. [DOI: 10.1016/j.wneu.2017.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 11/25/2022]
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Martinez-del-Campo E, Moon K, Kalb S, Soriano-Baron H, Theodore N. Surgical Management of a Patient With Thoracic Spinal Cord Herniation. Neurosurgery 2015; 77:E492-8; discussion E498-9. [DOI: 10.1227/neu.0000000000000860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Thoracic spinal cord herniation (TSCH) is rare and likely underdiagnosed. It is characterized by ventral herniation of the spinal cord through a dural defect, effacement of the anterior subarachnoid space, and increased posterior subarachnoid space. We present here a case of TSCH diagnosed and surgically treated at Barrow Neurological Institute, along with supplemental intraoperative video.
CLINICAL PRESENTATION:
A 61-year-old man with a history of progressive myelopathy causing left lower-extremity weakness with associated numbness, impaired gait, foot drop, incontinence, and sexual impotence was referred without any previous treatment. Computed tomographic myelography and magnetic resonance imaging of the thoracic spine showed ventral spinal cord herniation at T3-T4. Neurological monitoring was recorded preoperatively and intraoperatively. The patient underwent left-sided posterolateral exploration via T3-T4 laminectomies and costotransversectomy for intradural cord release/detethering of the spinal cord with additional superior and inferior extension and repair of the dural defect. Arthrodesis was not considered necessary. After cord release, motor evoked potentials showed immediate improvement from baseline. Dural duplication was considered the cause of TSCH in this case. Total reduction of herniation was evident in postoperative images. The postoperative course was uneventful, and at the last follow-up, the patient had regained ambulation and sphincter control.
CONCLUSION:
Anterior displacement of the thoracic spinal cord should elicit consideration of herniation to prevent misdiagnosis and inadequate surgery. Surgical cord release and enlargement of the dural defect are safe and associated with good clinical outcomes.
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Affiliation(s)
- Eduardo Martinez-del-Campo
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Karam Moon
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Samuel Kalb
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Hector Soriano-Baron
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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