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Rairan LG, Henriquez A, Diaz G, Mejía JA, Gomez D, Ramon JF, Hakim EJ. Unveiling the Current Understanding of Idiopathic Spinal Cord Herniation: A Systematic Review. Spine Surg Relat Res 2024; 8:225-234. [PMID: 38868787 PMCID: PMC11165495 DOI: 10.22603/ssrr.2023-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/07/2023] [Indexed: 06/14/2024] Open
Abstract
Background Idiopathic spinal cord herniation (ISCH) is a rare condition that is characterized by ventral herniation of the spinal cord through a defect in the dura mater into the epidural space, with no identifiable cause. ISCH is frequently underdiagnosed, and the information available in case reports is limited. To provide an overview of the clinical manifestations and diagnosis of this condition, this study aims to conduct a review of reported cases of ISCH. Methods A literature review was carried out using seven databases. The search was conducted using the keywords "Idiopathic spinal cord herniation" OR "Idiopathic Ventral Spinal Cord Herniation" AND "Case report" OR "case series." Results A total of 92 relevant papers reporting 224 cases, besides the index case, were determined. Of the cases, 58.5% were females and the mean age was 50.7 (SD 13.2) years. Symptoms, diagnoses, and outcomes were similar between genders. The most common clinical signs included motor symptoms (82.6%), instability (61.3%), hypoesthesia (59.2%), and disturbance of thermal sensitivity (47.3%). Brown-Séquard syndrome was observed in 27.2% of the cases, and surgical treatment was employed in 89.7% of the cases. Conclusions ISCH is a pathology that is principally treated with surgical approach. This study provides valuable insights into the clinical manifestations and diagnosis of ISCH, which can aid in the early recognition and treatment of this rare condition.
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Affiliation(s)
- Luis Garcia Rairan
- Department of Neurosurgery, Universidad Nacional de Colombia, Bogotà, Colombia
| | | | - Gustavo Diaz
- Faculty of Medicine, Universidad El Bosque, Bogotá, Colombia
| | | | - Diego Gomez
- Department of Neurosurgery, Fundación Santa Fe, Bogotá, Colombia
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Sarigul B, Ogrenci A, Dalbayrak S. Surgical management of idiopathic thoracal ventral spinal cord herniation: a case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Abstract
Introduction
Idiopathic spinal cord herniation is a rare entity that is characterized by the displacement of the spinal cord through a defect in the dural layer and presents with symptoms of myelopathy. Surgical management usually results in good outcomes.
Case presentation
A 58-year-old female patient presented with weakness of both legs since four months. Her neurological examination showed paraplegia in the lower extremities, and ventral herniation was detected in the T9 vertebral level. The patient underwent surgery. Left T9 hemilaminectomy was followed by the reduction in the herniated spinal cord into its physiological location and the covering the anteriorly located dural defect via circumferentially covering the dural surface of the corresponding vertebral level. Postoperatively, the patient’s neurological status improved gradually and radiological scans showed a total reduction in the herniation.
Conclusion
Despite the rarity of the pathology, spinal cord herniation should be included in the differential diagnosis of the patients presenting with myelopathy or Brown–Séquard syndrome.
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Ghosh R, Velagapudi L, Montenegro TS, Hines K, Gonzalez GA, Mahtabfar A, Prasad S, Jallo J, Sharan A, Heller J, Harrop J. Operative versus Nonoperative Management of Idiopathic Spinal Cord Herniation: Effect on Symptomatology and Disease Progression. World Neurosurg 2021; 152:e149-e154. [PMID: 34033961 DOI: 10.1016/j.wneu.2021.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Idiopathic spinal cord herniation (ISCH) is a rare pathology characterized by extravasation of the spinal cord through a dural defect. The optimal algorithm for choosing operative or nonoperative management is not well elucidated, partially because of the rarity of this pathology. We present the largest single-center series of ISCH and compare operative treatment to conservative management. METHODS A retrospective case series of all patients evaluated for treatment of ISCH at our institution between 2010 and 2019 was conducted. Demographic variables, presenting symptoms, and imaging characteristics were assessed for all patients. For patients who underwent operative treatment, surgical approach, postoperative course, and discharge outcomes were recorded. Follow-up notes were reviewed for status of symptoms and functional capabilities, which were synthesized into Odom's criteria score. RESULTS Sixteen patients met the inclusion criteria for this study, 8 of whom underwent operative treatment. No significant differences were found between operative and nonoperative groups with regard to demographic variables or pathology characteristics. Odom's criteria scores for the operative cohort were 12.5% (1 of 8) Excellent, 62.5% (5 of 8) Good, 12.5% (1 of 8) Fair, and 12.5% (1 of 8) Poor. Odom's criteria scores for the nonoperative cohort were 16.7% (1 of 6) Excellent, 33.3% (2 of 6) Good, 16.7% (1 of 6) Fair, and 33.3% (2 of 6) Poor. There was no significant difference between Odom's criteria score distribution between the operative and nonoperative groups at latest follow up (P = 0.715). CONCLUSIONS Conservative management of spinal cord herniation is an option that does not preclude symptomatic improvement in patients with idiopathic spinal cord herniation.
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Affiliation(s)
- Ritam Ghosh
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lohit Velagapudi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thiago S Montenegro
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Glenn A Gonzalez
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aria Mahtabfar
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Srinivas Prasad
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joshua Heller
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Teng KX, Dimou J. Delayed cord tethering post-ventral dural repair of idiopathic thoracic cord herniation. J Clin Neurosci 2021; 88:1-4. [PMID: 33992165 DOI: 10.1016/j.jocn.2021.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/16/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ken X Teng
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia
| | - James Dimou
- Department of Surgery, University of Melbourne, Centre for Medical Research, 300 Grattan Street, Parkville, VIC 3050, Australia; Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia.
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Bakhsheshian J, Strickland BA, Liu JC. Ventral Thoracic Spinal Cord Herniation: Clinical Image and Video Illustration of Microsurgical Treatment. World Neurosurg 2020; 142:152-154. [PMID: 32599202 DOI: 10.1016/j.wneu.2020.06.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 01/15/2023]
Abstract
Idiopathic spinal cord herniation is a rare cause of progressive myelopathy that can result in severe disability. In the following report, an illustrative case and associated video in the surgical management of ventral thoracic spinal cord herniation is presented and discussed. Spinal cord herniation is most commonly observed in the thoracic spine and is characterized by ventral displacement of the spinal cord through a defect in the dura. Over time ventral herniation of the spinal cord can compromise its vascular perfusion, resulting in further ischemic injury. The etiology is unclear, but suspected to be either acquired or congenital. Multiple surgical techniques have been reported with the goal of detethering the cord and taking adjunctive measures in reducing the risk for re-herniation. Surgical management of thoracic spinal cord herniation carries great risks, although neurological outcomes are generally favorable with improvements reported in the majority of cases.
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Affiliation(s)
- Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John C Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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