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Bansal K, Guha M, Gupta A. Spontaneous-Onset Delayed Spinal Arachnoiditis With Dorsal Cord Herniation in a 29-Year-Old Paraplegic Patient: A Case Report. Cureus 2023; 15:e51374. [PMID: 38292951 PMCID: PMC10825720 DOI: 10.7759/cureus.51374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Spinal adhesive arachnoiditis is a rare occurrence with a diverse etiology. The clinical picture is not universal, and varying degrees of neurodeficit have been mentioned. Spontaneous spinal cord herniation or idiopathic spinal cord herniation occurs due to displacement of the cord through a dural or arachnoid defect. We report a case of a 29-year-old male paraplegic patient with a nontraumatic spinal cord injury (SCI) following surgery for an intradural extramedullary lesion at T10-T11 level who developed loss of truncal balance after two years of the index surgery. After a thorough clinical examination and MRI as well as other investigations, the patient was diagnosed as having spontaneous-onset delayed spinal arachnoiditis with dorsal cord herniation through the laminectomy window with effacement of neural tissue and ascending edema up to T6 level. A new-onset weakness or the development of an ascending loss of sensory level with a loss of truncal balance should alarm the therapist about some new pathology happening at the cord level in patients with SCI. In this regard, spinal adhesive arachnoiditis with or without cord herniation should always be suspected in a paraplegic patient with delayed-onset deterioration of neurology. Differential diagnoses like arachnoid web and arachnoid cysts should also be kept in mind.
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Affiliation(s)
- Kuldeep Bansal
- Spine Services, Indian Spinal Injuries Center, New Delhi, IND
| | - Mayukh Guha
- Spine Services, Indian Spinal Injuries Center, New Delhi, IND
| | - Anuj Gupta
- Spine Surgery, Max Superspeciality Hospital, New Delhi, IND
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2
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Kaida M, Hirata H, Noda H, Kishikawa Y, Yoshihara T, Kobayashi T, Tsukamoto M, Mawatari M, Morimoto T. Early detection of idiopathic thoracic ventral spinal cord herniation by using imaging: A case report. Clin Case Rep 2023; 11:e8112. [PMID: 37953892 PMCID: PMC10636536 DOI: 10.1002/ccr3.8112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
In middle-aged and older populations, clinicians often suspect lumbar spine disease when the gait is disturbed with lumbar lower extremity numbness, but spinal herniation at the thoracic level may be causal. Early detection, appropriate treatment, and minimization of complications requires understanding of characteristic magnetic resonance imaging findings of herniation.
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Affiliation(s)
- Mana Kaida
- Faculty of MedicineSaga UniversitySagaJapan
| | - Hirohito Hirata
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | | | | | - Tomohito Yoshihara
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Takaomi Kobayashi
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masatsugu Tsukamoto
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Tadatsugu Morimoto
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
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3
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Hunziker S, Örgel A, Tatagiba M, Adib SD. Case report: A vertebral bone spur as an etiology for spinal cord herniation: case presentation, surgical technique, and review of the literature. Front Surg 2023; 10:1238448. [PMID: 37614664 PMCID: PMC10442939 DOI: 10.3389/fsurg.2023.1238448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Objective The pathophysiology of idiopathic spinal cord herniation remains unknown. However, several different factors have been postulated, such as congenital causes (ventral dura mater duplication, preexisting pseudomeningocele, or other congenital dural defects), inflammation, remote spinal trauma, or thoracic disc herniation. Herein, the diagnosis and surgical treatment of a patient with spinal cord herniation caused by an intraspinal bone spur is presented along with a relevant literature review. Case presentation A 56-year-old male patient presented with a non-traumatic Brown-Sequard syndrome persisting for over 1 year. A magnetic resonance imaging of the spinal axis revealed a ventral spinal cord displacement in the level of T 6/7. A supplementary thin-sliced computed tomography of the spine revealed a bone spur at the same level. For neurosurgical intervention, T 6 and T 7 laminectomy was performed. The cranial and caudal end of the right paramedian ventral dural defect was visualized and enlarged. Following extradural spinal cord mobilization by denticulate ligament transection, the spinal cord was finally released. The spinal cord was rotated and the ventral closure of the dural defect was performed by continuous suture. The patient recovered from surgery without additional deficits. The patient's postoperative gait, sensory, and motor function deficits improved, and further neurological deterioration was prevented. Conclusion Since the first description of spinal cord herniation by Wortzman et al. in 1974, approximately 260 cases have been reported in the literature. In addition to other causes, intraspinal bone spur is a possible cause of spinal cord herniation.
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Affiliation(s)
- S. Hunziker
- Department of Neurosurgery, University of Tuebingen, Tübingen, Germany
| | - A. Örgel
- Department of Diagnostic and Interventional Neuroradiology, University of Tuebingen, Tübingen, Germany
| | - M. Tatagiba
- Department of Neurosurgery, University of Tuebingen, Tübingen, Germany
| | - S. D. Adib
- Department of Neurosurgery, University of Tuebingen, Tübingen, Germany
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4
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Konan L, Derou L, Haidara A. CERVICAL SPINAL CORD HERNIATION AFTER LAMINECTOMY. World Neurosurg 2023:S1878-8750(23)00828-8. [PMID: 37355171 DOI: 10.1016/j.wneu.2023.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
Following a recent cervical laminectomy, a 67-year-old female patient exhibited the development of neck pain and torticollis after a coughing episode. On physical examination, manifestations of neck pain, stiffness, and 4/5 quadriparesis were noted. Magnetic Resonance Imaging (MRI) findings indicated the presence of herniation of the cervical medulla, accompanied by cerebrospinal fluid (CSF) leakage. Consequently, surgical intervention was performed to reposition the herniated cord within its original subarachnoid space, thereby averting potential recurrence. The patient experienced complete resolution of symptoms within a few days postoperatively. It is important to recognize that postoperative cervical spinal cord herniation following laminectomy is an infrequent complication that manifests with a delayed onset. Surgical repair serves as the main therapeutic modality.
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Affiliation(s)
- Landry Konan
- Department of Neurosurgery CHU Yopougon, UFR Sciences Medicales Abidjan, University Felix Houphouet Boigny, Cote d'Ivoire.
| | - Louis Derou
- Department of Neurosurgery CHU Bouaké, UFR Sciences Medicales Bouaké, University Alassane Ouattara, Cote d'Ivoire
| | - Aderehime Haidara
- Department of Neurosurgery CHU Bouaké, UFR Sciences Medicales Bouaké, University Alassane Ouattara, Cote d'Ivoire
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5
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Kamamura M, Higaki F, Sasada S, Matsushita T, Yasuhara T, Date I, Hiraki T. A Rare Case of Idiopathic Spinal Cord Herniation Treated by DuraGen® Collagen Matrix Graft. Acta Med Okayama 2022; 76:731-736. [PMID: 36549776 DOI: 10.18926/amo/64124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report a rare case of idiopathic spinal cord herniation (ISCH) with a history of cerebrospinal fluid (CSF) leakage. ISCH is a protrusion of the spinal cord through a dural defect. Thin constructive interference in steady-state (CISS) images clearly demonstrated the herniated cord in the present case. The myelopathy worsened and the patient underwent surgery for reduction of herniated spinal cord; the dural defect was filled by placing collagen matrix graft (DuraGen®) between the inner and outer dural layers. The patient's symptoms have improved without relapse for 8 months since surgery. This method may be a good surgical option for cases of spinal cord herniation.
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Affiliation(s)
- Maho Kamamura
- Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Fumiyo Higaki
- Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Susumu Sasada
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Toshi Matsushita
- Division of Radiological Technology, Okayama University Hospital
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao Date
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takao Hiraki
- Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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6
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Tomoda Y, Ando T, Hashimoto R, Nakamura S, Kubota M, Fukutake T. [A case of idiopathic spinal cord herniation with incomplete Brown-Séquard syndrome]. Rinsho Shinkeigaku 2022; 62:797-800. [PMID: 36184414 DOI: 10.5692/clinicalneurol.cn-001767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 50-year-old man was referred to our hospital with myelitis associated with a 10-months history of progressive muscle weakness in the left leg. Neurological examinations demonstrated diffuse muscle weakness of the left leg, touch hypoesthesia of the right leg, reduced pain sensation below the right nipple, left pyramidal sign, and urinary incontinence. On the basis of thoracic spinal MRI and thoracic CT myelography, revealing anterior displacement of the spinal cord and enlargement of the posterior subarachnoid space at the Th4 vertebral level, we diagnosed the patient as having idiopathic spinal cord herniation with incomplete Brown-Séquard syndrome. After microsurgical release of the spinal cord and subsequent covering of the anterior dural defect with an artificial dura mater, the symptoms improved without progression. Clinicians should consider spinal cord herniation as a cause of slowly progressive thoracic myelopathy with Brown-Séquard syndrome.
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Affiliation(s)
- Yoko Tomoda
- Department of Neurology, Kameda Medical Center
- Present Address: Department of Neurology, Kyoto University Graduate School of Medicine
| | - Tetsuo Ando
- Department of Neurology, Kameda Medical Center
| | | | | | - Motoo Kubota
- Department of Neurospinology, Kameda Medical Center
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7
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Ogbu I, Eltoukhy M, Tzerakis N. Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case. J Neurosurg 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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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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 J Med Sci 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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Huang ZX, Deng WM, Guo X, Lin CL, Li TW. Lumbar bone erosion with anterior dural ectasia in ankylosing spondylitis: a case report. J Int Med Res 2019; 47:1395-1400. [PMID: 30782057 PMCID: PMC6421385 DOI: 10.1177/0300060519827701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Bony erosion and dural ectasia rarely occur in the posterior part of the
vertebral body in ankylosing spondylitis (AS). Because of the compression of
nerve tissue that adheres to the inflamed dura mater, a range of neurologic
symptoms may develop. Few studies have investigated therapies for this
condition, and surgical intervention might alleviate the neurologic dysfunction.
Here, we report an uncommon case of lumbar spinal cord herniation secondary to
anterior dural ectasia in a patient with AS. The patient had a 31-year history
of AS and presented with progressive numbness and weakness of his left leg that
had lasted for nearly 1 month. Magnetic resonance imaging (MRI) revealed a dural
defect in the posterior aspect of the L1 and L2 vertebral bodies, with
displacement of the nerve tissue adjacent to the lytic lesion. The patient
declined surgery and was prescribed oral meloxicam. The neurological symptoms of
the left leg remained stable during 2 years of follow-up. The dural enhancement
on MRI resolved, although the erosion-like lesion in the vertebral bodies
persisted. This unusual case supports the central role of inflammation in
anterior dural ectasia of patients with AS. Anti-inflammatory treatment may be
an alternative therapy for patients who decline surgery.
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Affiliation(s)
- Zhi-Xiang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wei-Ming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xin Guo
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chu-Lan Lin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tian-Wang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
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10
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Abstract
Background Spinal cord herniation (SCH) is an uncommon cause of myelopathy. Documented trauma is a rare cause, and most cases are idiopathic. One special type of trauma that may lead to SCH is a brachial plexus injury. We report a case of SCH with delayed neurological symptoms after a brachial plexus injury. We reviewed the literature and illustrated the closing technique as described by Batzdorf. Case Description Following a motor vehicle accident, a 27-year-old male sustained a brachial plexus injury and multiple left-sided nerve root avulsions (C6, C7, and C8) resulting into a full paralysis of the left arm. There was also a loss of pain and temperature sensation on the right side of the body. He underwent reconstructive surgery without any functional improvement. After 6 to 7 years his condition worsened. Magnetic resonance imaging revealed a left-sided SCH at the level of C7. He underwent a C6-C7 laminectomy which revealed a pseudomeningocele at C6-C7 accompanied by focal SCH at the location of the C7 root. The SCH was reduced intradurally and the dural defect of the meningocele was covered with a Neuropatch membrane wrapped around the spinal cord (between the spinal cord and the dura) according to the technique described by Batzdorf. Postoperatively, the neurological symptoms improved. Conclusion SCH should be surgically repaired utilizing the technique described by Batzdorf if further neurological deficits develop.
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Affiliation(s)
- Sven Bamps
- Department of Neurosurgery, University Hospital Leuven, Belgium
| | - Eric Put
- Department of Neurosurgery, Jessa Hospital Hasselt, Belgium
| | - Peter Soors
- Department of Neurology, Jessa Hospital Hasselt, Belgium
| | - Termote Bruno
- Department of Radiology, Jessa Hospital Hasselt, Belgium
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Abstract
Idiopathic spinal cord herniation is a rare and often missed cause of thoracic myelopathy. The clinical presentation and radiological appearance is inconsistent and commonly confused with a dorsal arachnoid cyst and often is a misdiagnosed entity. While ventral spinal cord herniation through a dural defect has been previously described, intravertebral herniation is a distinct entity and extremely rare. We present the case of a 70-year old man with idiopathic thoracic transdural intravertebral spinal cord herniation and discuss the clinico-radiological presentation, pathophysiology and operative management along with a review the literature of this unusual entity.
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Affiliation(s)
- Mazda K Turel
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Joshua T Wewel
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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12
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Bartels RHMA, Brunner H, Hosman A, van Alfen N, Grotenhuis JA. The Pathogenesis of Ventral Idiopathic Herniation of the Spinal Cord: A Hypothesis Based on the Review of the Literature. Front Neurol 2017; 8:476. [PMID: 28955299 PMCID: PMC5601982 DOI: 10.3389/fneur.2017.00476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/28/2017] [Indexed: 12/29/2022] Open
Abstract
Idiopathic ventral herniation of the spinal cord (SC) is not often encountered in daily practice. Its clinical prevalence, however, will increase through increasing awareness and more frequent use of MRI. A clear explanation of its pathophysiology has never been formulated. It was hypothesized that the findings during surgery might indicate the real causative mechanism. An extensive literature search was performed, using Embase, PubMed, and Google Scholar. Titles and abstracts were screened by two investigators, using strict inclusion and exclusion criteria. Reference lists of the full paper versions of each included article were checked. The following data were registered for the articles included: age, gender, level of herniation, relation to intervertebral disk, duration of symptoms, findings from surgery, and outcomes. Nine cases treated at our department were added. A total of 117 articles reporting on 259 patients were included. Including our cases, 268 patients were reviewed. Females outnumbered males (160/100). The mean age was 51.3 ± 12.0 years. In 236 patients, the duration of symptoms was reported: 55.5 ± 55.6 months. In 178 patients, the intraoperative findings for the herniated part of the SC were not mentioned. In 59 patients, a tumor-like extrusion was seen, without any alteration to the SC. Deformation of the SC itself was never observed. Biopsies of these structures were without clinical consequence. Based on the intraoperative findings reported in literature and the cases presented, acquired causes, such as trauma and erosion of the dura due to a herniated disk, were not plausible. We hypothesize that a non-functioning appendix to the SC can only develop during an early embryologic phase, in which several layers separate. We propose renaming this entity as congenital transdural appendix of the SC.
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Affiliation(s)
- Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Han Brunner
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Allard Hosman
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - J André Grotenhuis
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
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13
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Imai T, Nakane Y, Tachibana E, Ogura K. Spinal cord herniation with characteristic bone change: a case report. Nagoya J Med Sci 2015; 77:515-20. [PMID: 26412899 PMCID: PMC4574340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
Spinal cord herniation (SCH) is a rare disease characterized by herniation of the thoracic spinal cord through an anterior dural defect, presenting with progressive myelopathy. A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented. The strangled spinal cord was released, and the defect was closed microsurgically using an artificial dural patch to prevent re-herniation. Postoperatively, the patient experienced gradual improvement in neurologic function. The SCH mechanism and surgical strategy are discussed.
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Affiliation(s)
- Tasuku Imai
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Japan
| | - Yukimi Nakane
- Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Japan
| | - Eiji Tachibana
- Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Japan
| | - Koichiro Ogura
- Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Japan
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14
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Abstract
Spinal cord herniation is a relatively rare but increasingly recognized clinical entity, with fewer than 200 cases reported in the literature to date. The etiology of this condition remains unknown, and surgery is used as the primary treatment to correct the herniation and consequent spinal cord compromise. Some patients without clinical progression have been treated with nonoperative measures, including careful follow-up and symptomatic physical therapy. To date, however, there has been no published report on the resolution of spinal cord herniation without surgical intervention. The patient in the featured case is a 58-year-old man who presented with mild thoracic myelopathy and imaging findings consistent with idiopathic spinal cord herniation. Surprisingly, updated MRI studies, obtained to better delineate the pathology, showed spontaneous resolution of the herniation. Subsequent MRI 6 months later revealed continued resolution of the previous spinal cord herniation. This is the first report of spontaneous resolution of a spinal cord herniation in the literature. At present, the treatment of this disorder is individualized, with microsurgical correction used in patients with progressive neurological impairment. The featured case highlights the potential variability in the natural history of this condition and supports considering an initial trial of nonoperative management for patients with mild, nonprogressive neurological deficits.
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Affiliation(s)
| | | | - Carlo Santaguida
- Division of Neurosurgery, Spinal Program, University of Toronto;,Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Spinal Program, University of Toronto;,Department of Genetics and Development, Toronto Western Hospital; and.,Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
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15
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Moses JE, Bansal SK, Goyal D. Herniation of spinal cord into nerve root avulsion pseudomeningocele: A rare cause of delayed progressive neurological deficit. Indian J Radiol Imaging 2013; 23:205-7. [PMID: 24347848 PMCID: PMC3843326 DOI: 10.4103/0971-3026.120260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a patient with old traumatic right brachial plexus injury, who developed progressive neurological deterioration 4 years after the initial injury. On magnetic resonance imaging (MRI), herniation of the upper dorsal cord was noted into a post-traumatic pseudomeningocele. Though the herniation of cord into a post-traumatic pseudomeningocele is very rare, it should be suspected in cases of delayed progressive myelopathy. A three dimensional (3-D) T2-weighted sequence such as Sampling Perfection with Application optimized Contrasts using different flip angle Evolution (SPACE) or constructive interference in steady state (CISS) provides optimal visualization of the herniated cord and helps in surgical planning.
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Affiliation(s)
| | | | - Deepak Goyal
- Department of Radiology, Arora Neuro Centre, Ludhiana, Punjab, India
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Abstract
Idiopathic spinal cord herniation (ISCH) is a rare condition, of unknown pathogenesis, that primarily affects the thoracic spinal cord. It is characterized by ventral displacement of the spinal cord through a dural defect. The aim of this study was to review the literature and to present a retrospective single center experience with three cases of ISCH. The literature review analyzed a total of 78 relevant publications on ISCH, which included a total of 171 patients, supplemented with 3 patients treated at our institution. Numerous case reports have demonstrated improvement in clinical outcomes after surgery; however, follow-up is predominantly short, data are incomplete, the condition is frequently misdiagnosed, and it is difficult to predict which patients will benefit from surgery. We identified 159 cases treated with surgical management. The mean symptom duration was 54 months, and the mean follow-up 33 months. The result at follow-up was improved neurological outcome in 74%, unchanged result in 18%, and worse outcome in 8%. There were 15 cases of conservative management, with mean symptom duration 52 months and mean follow-up 33 months. The neurological outcome was unchanged in 100%. ISCH is a rare condition causing progressive thoracic myelopathy, and the natural history is unknown. There is a lack of evidence-based treatment strategies, and the majority of cases are treated with surgical management at diagnosis. Management of ISCH needs to be individualized for each patient, and clinicians should be encouraged to report new cases, standardize case reports, and ensure long-term follow-up.
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Affiliation(s)
- Johanne C Summers
- Department of Neurosurgery, The Alfred Hospital, Victoria, Australia
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