Idiopathic ventral spinal cord herniation: a rare presentation of tethered cord

2010 ◽  
Vol 29 (1) ◽  
pp. E10 ◽  
Author(s):  
John H. Shin ◽  
Ajit A. Krishnaney
Keyword(s):  
Spinal Cord ◽  
Natural History ◽  
Surgical Techniques ◽  
Tethered Cord ◽  
Rare Condition ◽  
Review Article ◽  
Optimal Management ◽  
Rare Presentation ◽  
Spinal Cord Herniation ◽  
Ventral Spinal Cord

Idiopathic ventral spinal cord herniation is a rare condition that has been increasingly reported in the last decade. The natural history and optimal management have yet to be defined. Therefore, debate exists regarding the pathogenesis and surgical management of this condition. The purpose of this review article is to further educate neurosurgeons about the surgical techniques and outcomes associated with treating this rare and often misdiagnosed condition.

Idiopathic Ventral Spinal Cord Herniation: Video Report and Systematic Review

2020 ◽  
Vol 139 ◽  
pp. 592-602
Author(s):  
Eduardo Augusto Iunes ◽  
Enrico Affonso Barletta ◽  
Fernando Seiji Suzuki ◽  
Telmo Augusto Barba Belsuzarri ◽  
Daniel de Araújo Paz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Herniation ◽  
Ventral Spinal Cord

Dorsal spinal cord herniation at the thoracolumbar junction presenting with scalloping of ossification of the ligamentum flavum: case report

2020 ◽  
Vol 32 (1) ◽  
pp. 56-60
Author(s):  
Takahiro Makino ◽  
Shota Takenaka ◽  
Gensuke Okamura ◽  
Yusuke Sakai ◽  
Hideki Yoshikawa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Dura Mater ◽  
Ligamentum Flavum ◽  
Rare Condition ◽  
Thoracolumbar Junction ◽  
Gait Ataxia ◽  
Dorsal Spinal Cord ◽  
Epidural Catheter Placement ◽  
Spinal Cord Herniation ◽  
Dorsal Spinal

Dorsal spinal cord herniation is reportedly a rare condition. Here, the authors report an unusual case of dorsal spinal cord herniation at the thoracolumbar junction presenting with scalloping of ossification of the ligamentum flavum (OLF). A 75-year-old woman with a 2-year history of bilateral leg dysesthesia presented with progressive gait ataxia. Neurological examination showed bilateral patellar tendon hyperreflexia with loss of vibratory sensation and proprioception in her bilateral lower extremities. CT myelography revealed a posterior kink and dorsal herniation of the spinal cord at T11–12, with OLF between T10–11 and T12–L1. In addition, scalloping of the OLF was observed at T11–12 at the site of the herniated spinal cord. This scalloping was first noted 9 years previously and had been gradually progressing. The patient underwent surgical repair of the spinal cord herniation. Subsequently, her spinal cord herniation and vibratory sensation and proprioception in both legs partly improved, but gait ataxia remained unchanged. Dorsal spinal cord herniation reportedly occurs under conditions of vulnerability of the dorsal dura mater. In this case, acquired vulnerability of the dorsal dura mater owing to previous epidural catheter placement into the thoracolumbar space may have resulted in dorsal spinal cord herniation.

Release and repair of a ventral thoracic spinal cord herniation

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video5 ◽  
Author(s):  
Paul C. McCormick
Keyword(s):  
Spinal Cord ◽  
Posterior Approach ◽  
Primary Repair ◽  
Surgical Techniques ◽  
Thoracic Spinal Cord ◽  
Hernia Defect ◽  
Progressive Myelopathy ◽  
Thoracic Spinal ◽  
Imaging Characteristics ◽  
Spinal Cord Herniation

Ventral thoracic spinal cord herniation is a rare but increasingly recognized cause of progressive myelopathy. This video demonstrates the imaging characteristics and surgical techniques for release and reduction of the spinal cord herniation as well as primary repair and reinforcement of the ventral dural hernia defect through an extended posterior approach. An instrumented fusion was concomitantly performed.The video can be found here: http://youtu.be/6Pcokep6Tug.

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 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.

Herniation of the spinal cord

1995 ◽  
Vol 82 (1) ◽  
pp. 131-136 ◽  
Author(s):  
Rakesh Kumar ◽  
Jamal Taha ◽  
Alson Lee Greiner
Keyword(s):  
Spinal Cord ◽  
Rare Condition ◽  
Spinal Curvature ◽  
Sensory Level ◽  
Dural Defect ◽  
Content Type ◽  
Spinal Cord Herniation ◽  
Left Limb ◽  
Meningeal Cysts ◽  
Fine Print

✓ Herniation of the spinal cord, or displacement of the cord outside the dura, is so rare that only 13 cases have been reported in the literature. The authors report a new case of spontaneous herniation of the spinal cord in a 38-year-old man who presented with lower left limb paresis and Brown-Séquard syndrome, with a T-8 sensory level. Displacement of the spinal cord was noted on computerized tomography following myelography and on magnetic resonance imaging. The herniated cord was confirmed at operation and reduced intradurally. Postoperatively, the patient showed complete neurological recovery. Based on a review of the literature, herniation of the spinal cord may be classified as spontaneous, iatrogenic, or traumatic. At cervical levels, the spinal cord has herniated into an iatrogenic pseudomeningocele located dorsally. At thoracic levels, spinal cord herniations were reported to be in a preexisting extradural arachnoid cyst located ventrally. The authors propose a pathogenesis for spinal cord herniation based on abnormal positioning of the spinal cord in the dural sleeve and the known anteroposterior movements of the cord that occur with cardiac and respiratory pulsations. The presence of a dural defect situated on the concavity of the spinal curvature is a prerequisite for this rare condition. As adhesions develop between the cord and the edges of the dural defect, cerebrospinal fluid pulsations push the cord into a preexisting cyst. The authors suggest modifying the classification by Nabors, et al., of spinal meningeal cysts to include this mechanism of spinal cord herniation. This diagnosis should also be considered in the differential diagnosis of myelopathy in the absence of a mass lesion.

Permanent Paraplegia as a Complication of Injection of Contrast Media at L2-L3 Vertebral Level

Pain Medicine ◽  
2019 ◽  
Author(s):  
Adarsh B Shukla ◽  
To-Nhu Vu ◽  
Yakov Vorobeychik
Keyword(s):  
Spinal Cord ◽  
Contrast Medium ◽  
Tethered Cord ◽  
Rare Condition ◽  
Diagnostic Procedures ◽  
The United States ◽  
Neurological Complications ◽  
Imaging Studies ◽  
Vertebral Level ◽  
Patient Reported

Abstract Background The lumbar intrathecal (subarachnoid) space is accessed for both therapeutic and diagnostic purposes. Occasionally, the needle may unintentionally enter the intrathecal space during lumbar interlaminar epidural steroid injections (LESIs)—one of the most commonly performed medical procedures in the United States. Ordinarily, this merely constitutes a minor complication or even a desired placement (in the case of some diagnostic procedures). However, some patients have a rare condition wherein the spinal cord terminates below the L2 vertebral level (tethered cord). In such cases, injections administered at the lumbar level may potentially result in spinal cord damage and irreversible paraplegia if the physician performing the intervention does not recognize the intramedullary position of the needle. Objective The aim of this study is to describe and analyze an unintentional L2-L3 injection of contrast medium into a tethered spinal cord. Many physicians may consider lumbar injections “safe” because the spinal cord usually terminates at or above the L2 vertebral level. However, complacency stemming from this false impression of safety contributes to nonadherence to practice guidelines, which may lead to catastrophic neurological complications. Presented here is the first published occurrence of paraplegia that resulted from contrast medium injection into the spinal cord during a myelography study performed below the L2 vertebral level. Conclusions Disregard of the procedural guidelines by the physicians performing an elective diagnostic intervention may cause devastating neurological complications. The described casualty occurred because of failure to review previous imaging studies, injection of the contrast medium despite unsuccessful attempts to aspirate cerebrospinal fluid, and an unwillingness to terminate the procedure immediately when the patient reported an unusual sensation in both of his lower extremities. Consequently, we suggest that not only for cervical and thoracic but also for lumbar interlaminar ESIs, previous imaging studies should be reviewed before the injection.

scholarly journals Dorsal arachnoid web

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video8
Author(s):  
Paul C. McCormick
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Progressive Myelopathy ◽  
Link Type ◽  
Spinal Cord Herniation ◽  
Ventral Spinal Cord

Dorsal thoracic arachnoid web is a rare but often overlooked cause of progressive myelopathy. Syringomyelia, either above or below the compressive arachnoid band, may also be present. Dorsal arachnoid cyst and ventral spinal cord herniation may be mistaken for this condition. This video demonstrates the microsurgical identification and techniques of resection of a dorsal arachnoid band producing a progressive myelopathy in a 63-year-old man.The video can be found here: http://youtu.be/KDNTqiyW6yo.

scholarly journals Spinal Cord Suspension Using Dentate Ligament Hitch Stitches: A Novel Technique for the Repair of Ventral Spinal Cord Herniation

2017 ◽  
Vol 14 (3) ◽  
pp. 252-258 ◽  
Author(s):  
Jonathan Lui ◽  
Parag Sayal ◽  
David Choi
Keyword(s):  
Spinal Cord ◽  
Standard Technique ◽  
Resonance Imaging ◽  
Novel Technique ◽  
Early Results ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Dural Patch ◽  
Dentate Ligament ◽  
Ventral Spinal Cord

Abstract BACKGROUND Idiopathic spinal cord herniation is usually repaired by releasing the spinal cord and inserting a dural patch to close the herniated segment of dura. However, reherniation is a potential limitation of this standard technique. OBJECTIVE To describe early results of a novel technique that utilizes the dentate ligament to hitch the spinal cord and prevent reherniation. METHODS Two patients underwent dural hernia repair and the dentate hitch technique was performed. RESULTS Restored lower limb power and mobility, and satisfactory reduction of spinal cord herniation on magnetic resonance imaging in 2 patients at 6- and 24-mo follow-ups, respectively. CONCLUSION The dentate hitch technique can achieve repair of spinal cord herniation, with satisfactory postoperative results and minimizes the risk of reherniation.

scholarly journals Posterior Surgical Approach for Ventral Cervical Spinal Cord Herniation: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Anthony Diaz ◽  
S Shelby Burks ◽  
Richard Fisher ◽  
Allan D Levi
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Surgical Approach ◽  
Anterior Approach ◽  
Cervical Spinal Cord ◽  
Rare Condition ◽  
Residual Tumor ◽  
Neurological Deficits ◽  
Dural Defect ◽  
Spinal Cord Herniation

Abstract Spinal cord herniation (SCH) is a rare condition that is typically of idiopathic origin. Although SCH is mostly found in the thoracic region because of a dural defect, there are some reports of cervical SCH following surgery or trauma.1-3 Spinal cord tethering can be a result of SCH or as a standalone issue.4,5 These conditions can lead to progressive neurological deficits, including numbness, gait disturbances, and decreased muscle strength, requiring surgical correction. There are limited reports of surgical procedures for ventral SCHs. Several reports exist using a ventral approach for intradural tumors, but it is not commonly employed because of the inability to obtain adequate dural closure.6 Much of the literature on SCH comes from idiopathic and congenital cases in the thoracic spine.7,8 Posterior and posterolateral approaches for a ventral thoracic SCH have been described, as well as an anterior approach for a ventral cervical SCH.9-12 In this video, we describe a posterior approach for a ventral cervical SCH. A 38-yr-old male presented with progressive cervical myelopathy 9 yr after a C2-C3 schwannoma resection requiring an anterior approach and corpectomy of C3 with partial corpectomies of C2 and C4. A preoperative magnetic resonance imaging showed a ventrally herniated spinal cord at the top of the C3 vertebral body and below the C4 vertebral body. Informed consent was obtained. The posterior surgical approach involved a C1-C5 laminectomy, sectioning the dentate ligament, ventral cord untethering, removal of residual tumor, and placement of a ventral sling. A significant improvement in sensory and motor function was observed postoperatively.

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