scholarly journals Thoracic ventral spinal cord herniation with progressive myelopathy – A case report and review of the literature

2021 ◽  
Vol 12 ◽  
pp. 382
Author(s):  
Taylor Anne Wilson ◽  
Ramachandran Pillai Promod Kumar ◽  
Emmanuel Omosor
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Case Description ◽  
Review Of The Literature ◽  
Imaging Studies ◽  
Thoracic Myelopathy ◽  
Progressive Myelopathy ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Ventral Spinal Cord

Background: Idiopathic spinal cord herniation (ISCH) is a rare, underrecognized, and often misdiagnosed entity of unclear pathogenesis that typically presents as a slowly progressive thoracic myelopathy. There are less than 200 such cases reported in the literature. ISCH diagnosis and treatment are often delayed contributing to greater fixed neurological deficits, often leading to costly, unnecessary imaging studies, and inappropriate surgery. Case Description: Here, a 48-year-old female presented with trauma-induced ISCH characterized by gradually worsening lower extremity myelopathy. Conclusion: Idiopathic spinal cord herniation (ISCH) is rare, often underdiagnosed posttraumatic myelopathy that, when accurately diagnosed and treated, can result in good outcomes.

scholarly journals Spontaneous resolution of idiopathic thoracic spinal cord herniation: case report

2015 ◽  
Vol 23 (3) ◽  
pp. 306-308 ◽  
Author(s):  
Nardin Samuel ◽  
Christina L. Goldstein ◽  
Carlo Santaguida ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Neurological Impairment ◽  
Primary Treatment ◽  
Spontaneous Resolution ◽  
Neurological Deficits ◽  
Thoracic Myelopathy ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

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.

Surgical management of idiopathic spinal cord herniation: a review of nine cases treated by the enlargement of the dural defect

2001 ◽  
Vol 95 (2) ◽  
pp. 169-172 ◽  
Author(s):  
Masahiko Watanabe ◽  
Kazuhiro Chiba ◽  
Morio Matsumoto ◽  
Hirofumi Maruiwa ◽  
Yoshikazu Fujimura ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Dural Defect ◽  
Normal Position ◽  
Postoperative Results ◽  
Content Type ◽  
Progressive Myelopathy ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Fine Print

Object. Spinal cord herniation is a rare cause of progressive myelopathy and can be corrected surgically. In most previous reports, closure of the dural defect was the recommended procedure. The object of this paper is to describe a new procedure in which spinal cord constriction is released by enlarging the hiatus; additionally the postoperative results will be discussed. Methods. In nine patients with spinal cord herniation, enlargement of the dural defect was performed. In eight patients, neurological deficits resolved immediately after surgery. In one patient with a severe preoperative neurological deficit whose spinal cord herniated massively, deterioration occurred postoperatively. To date, no recurrence of herniation has been observed. Conclusions. The goals of surgery are to reduce the herniation, return the spinal cord to the normal position, and prevent the recurrence of herniation. The use of sutures to close the dural defect has been the method of choice to date. The surgical space in front of the spinal cord, however, is insufficient to accommodate this procedure safely. Because symptoms are caused by the constriction of the spinal cord at the hiatus, surgical expansion of the hiatus allows the goals of surgery to be achieved. This procedure, which is technically easier and less invasive with regard to the vulnerable spinal cord than the closure of the dural defect, could be a viable alternative for the treatment of this rare disease.

Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature

Neurosurgery ◽  
1999 ◽  
Vol 44 (5) ◽  
pp. 1129-1133 ◽  
Author(s):  
Laurence A.G. Marshman ◽  
Carl Hardwidge ◽  
Suzanne C. Ford-Dunn ◽  
John S. Olney
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Review Of The Literature ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

scholarly journals Idiopathic Ventral Spinal Cord Herniation: An Increasingly Recognized Cause of Thoracic Myelopathy

2014 ◽  
Vol 6 ◽  
pp. JCNSD.S16180 ◽  
Author(s):  
Jon Berg-Johnsen ◽  
Eivind Ilstad ◽  
Frode Kolstad ◽  
Mark Züchner ◽  
Jarle Sundseth
Keyword(s):  
Spinal Cord ◽  
Correct Diagnosis ◽  
Spastic Paraparesis ◽  
Dural Defect ◽  
Thoracic Myelopathy ◽  
Spinal Cord Herniation ◽  
Transient Improvement ◽  
Clinical Awareness ◽  
Idiopathic Spinal Cord Herniation ◽  
Dural Patch

Idiopathic spinal cord herniation (ISCH), where a segment of the spinal cord has herniated through a ventral defect in the dura, is a rarely encountered cause of thoracic myelopathy. The purpose of our study was to increase the clinical awareness of this condition by presenting our experience with seven consecutive cases treated in our department since 2005. All the patients developed pronounced spastic paraparesis or Brown-Séquard syndrome for several years (mean, 4.7 years) prior to diagnosis. MRI was consistent with a transdural spinal cord herniation in the mid-thoracic region in all the cases. The patients underwent surgical reduction of the herniated spinal cord and closure of the dural defect using an artificial dural patch. At follow-up, three patients experienced considerable clinical improvement, one had slight improvement, one had transient improvement, and two were unchanged. Two of the four patients with sphincter dysfunction regained sphincter control. MRI showed realignment of the spinal cord in all the patients. ISCH is probably a more common cause of thoracic myelopathy than previously recognized. The patients usually develop progressive myelopathy for several years before the correct diagnosis is made. Early diagnosis is important in order to treat the patients before the myelopathy has become advanced.

Operative Management of Idiopathic Spinal Cord Herniation: Case Series and Novel Technique for Repair of Recurrent Herniation

2018 ◽  
Vol 16 (4) ◽  
pp. 415-423 ◽  
Author(s):  
Randall J Hlubek ◽  
David S Xu ◽  
Celene B Mulholland ◽  
Jourdan Gilson ◽  
Nicholas Theodore ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pathological Condition ◽  
Case Series ◽  
Collagen Matrix ◽  
Operative Management ◽  
Dural Defect ◽  
Thoracic Myelopathy ◽  
Lower Extremity Weakness ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

Abstract BACKGROUND Idiopathic spinal cord herniation (ISCH) is a rare pathology of the spine defined by herniation of the spinal cord through a dural defect. OBJECTIVE To highlight the operative management of ISCH and the surgical nuances of ISCH repairs conducted at our institution. METHODS This retrospective review examines consecutive patients with ISCH who were treated surgically between January 1, 2010, and July 31, 2017, at Barrow Neurological Institute, Phoenix, Arizona. RESULTS Four patients with ISCH presented with thoracic myelopathy and lower extremity weakness during the study period. Treatment consisted of reduction of the herniated spinal cord and filling of the dural defect with a collagen-based dural regeneration matrix. In 3 patients the dural edges were covered with a collagen-matrix intradural sling, and in 1 patient they were repaired primarily with interrupted sutures. Three of the 4 patients experienced improvement in myelopathic symptoms; the fourth patient suffered neurological decline in the immediate postoperative period. CONCLUSION ISCH is a complex pathological condition likely to result in progressive myelopathy. Surgery offers patients the possibility of stabilizing the progression of the spinal cord dysfunction and perhaps restoring neurological function. However, extreme care must be taken during surgery to minimize manipulation of the fragile herniated cord.

scholarly journals A Case of Ventral Spinal Cord Herniation from a Chronic Dural-pleural Fistula Resulting in Thoracic Myelopathy

Cureus ◽  
2019 ◽  
Author(s):  
Ilyas Eli ◽  
Jian Guan ◽  
Michael Karsy ◽  
Marcus D Mazur ◽  
Andrew Dailey
Keyword(s):  
Spinal Cord ◽  
Thoracic Myelopathy ◽  
Spinal Cord Herniation ◽  
Ventral Spinal Cord

scholarly journals Thoracic idiopathic spinal cord herniation in a young patient: a diagnostic and therapeutic challenge

2019 ◽  
Vol 12 (5) ◽  
pp. e227847 ◽  
Author(s):  
D Gomez-Amarillo ◽  
C Garcia-Baena ◽  
D Volcinschi-Moros ◽  
F Hakim
Keyword(s):  
Spinal Cord ◽  
Posterior Approach ◽  
Dural Defect ◽  
Thoracic Myelopathy ◽  
Postoperative Mri ◽  
Younger Age ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Brown Sequard Syndrome

Idiopathic Spinal Cord Herniation (ISCH) is considered to be a rare cause of Thoracic Myelopathy. It is secondary to the gliding of the Spinal Cord through an anterior dural defect, without a completely defined cause. We present a case of ISCH which, even though was in its usual location, developed in a woman at a younger age than expected. The patient was 20 years old when diagnosed with Brown-Séquard Syndrome. MRI showed herniation at T4-T5 level, which was corrected using a posterior approach to expose the dural defect, reduce the herniation and place a heterologous graft. Postoperatively, neurological function improved, and adequate reduction was seen on imaging. Given the reports of recurrence and deterioration that have been seen after 18 months, follow-up was prolonged for a total of 2 years. We consider postoperative MRI performance important to establish the degree of reduction and alignment of the Spinal Cord.

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