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.

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.

Imaging Findings in Dorsal Thoracic Arachnoid Web and the Differential Diagnosis of “Scalpel Sign”

Neurographics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 96-102
Author(s):  
P.M. Brasil ◽  
L.P. Pereira ◽  
D.G.F. Távora ◽  
A.C.F. Camara ◽  
C.L. Macedo Filho ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Correct Diagnosis ◽  
Dural Defect ◽  
Imaging Findings ◽  
Thoracic Spinal Cord ◽  
Ventral Cord ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

A dorsal thoracic arachnoid web represents an intradural extramedullary transverse band of arachnoid tissue that causes mass effect and dorsal cord indentation, and can or cannot be associated with spinal cord altered signal. On sagittal MR imaging, this focal dorsal indentation of the thoracic spinal cord resembles a scalpel with its blade pointing posteriorly (called a “scalpel sign”). Although very suggestive of dorsal thoracic arachnoid web, this sign is not specific and should be differentiated from other ventral cord displacement causes (eg, idiopathic spinal cord herniation and spinal arachnoid cyst). In idiopathic spinal cord herniation, cord tissue protrudes through a ventral dural defect, and the focal deformity can be seen along the ventral aspect of the cord on spinal axial MR imaging and with a characteristic “C sign” on sagittal MR imaging; in spinal arachnoid cysts, the marginated walls and the presence of smooth, wide scalloping of the cord surface can be identified. Recognition of these imaging findings, especially the scalpel sign, can help radiologists and clinicians make a correct diagnosis of ventral cord displacement causes and allow subsequent prompt treatment for the patient.

Repair of Thoracic Spinal Cord Herniation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E161-E161
Author(s):  
Siri Sahib S Khalsa ◽  
Yamaan S Saadeh ◽  
Brandon W Smith ◽  
Jacob R Joseph ◽  
Mark E Oppenlander
Keyword(s):  
Spinal Cord ◽  
Lower Extremities ◽  
Urinary Symptoms ◽  
Dural Defect ◽  
Thoracic Myelopathy ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation ◽  
Patient Consent ◽  
Progressive Weakness

Abstract Spinal cord herniation is an uncommon surgically treatable cause of thoracic myelopathy and progressive paraplegia. The thoracic spinal cord focally protrudes through a defect in the dura, resulting in progressive weakness, numbness, and spasticity affecting the lower extremities, in addition to possible urinary symptoms. In this video, we present the case of a 69-yr-old female who presented with 3 yr of progressive thoracic myelopathy due to a thoracic spinal cord herniation at T4-T5. We demonstrate the surgical steps to lyse arachnoid webs, mobilize the spinal cord, reduce the spinal cord herniation, and repair the dural defect. Appropriate patient consent was obtained.

Superficial siderosis due to dural defect with thoracic spinal cord herniation

2012 ◽  
Vol 312 (1-2) ◽  
pp. 170-172 ◽  
Author(s):  
Giorgio B. Boncoraglio ◽  
Elena Ballabio ◽  
Alessandra Erbetta ◽  
Francesco Prada ◽  
Mario Savoiardo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation

Transdural herniation of the thoracic spinal cord: untethering via a posterolateral transpedicular approach

2004 ◽  
Vol 1 (2) ◽  
pp. 223-227 ◽  
Author(s):  
Ryder Gwinn ◽  
Fraser Henderson
Keyword(s):  
Spinal Cord ◽  
Posterior Approach ◽  
Thoracic Spinal Cord ◽  
Dural Repair ◽  
Content Type ◽  
Transpedicular Approach ◽  
Thoracic Spinal ◽  
Novel Approach ◽  
Spinal Cord Herniation ◽  
Thoracic Cord

✓ Anterior spinal cord herniation is a well-documented condition in which the thoracic cord becomes tethered within a defect in the anterior dura mater. Typical procedures have involved a posterior approach with direct manipulation of the thoracic cord to expose and blindly release its point of tethering. The authors report three cases in which a novel approach for the treatment of anterior thoracic cord herniation was performed, cord manipulation and traction are minimized, and direct dural repair of the defect is performed.

Histopathology of experimental hematomyelia

1991 ◽  
Vol 75 (6) ◽  
pp. 911-915 ◽  
Author(s):  
Thomas H. Milhorat ◽  
David E. Adler ◽  
Ian M. Heger ◽  
John I. Miller ◽  
Joanna R. Hollenberg-Sher
Keyword(s):  
Spinal Cord ◽  
Tissue Injury ◽  
Central Canal ◽  
Microglial Cells ◽  
Neurological Deficits ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal ◽  
Cellular Debris ◽  
Dorsal Columns

✓ The pathology of hematomyelia was examined in 35 rats following the stereotactic injection of 2 µl blood into the dorsal columns of the thoracic spinal cord. This experimental model produced a small ball-hemorrhage without associated neurological deficits or significant tissue injury. Histological sections of the whole spinal cord were studied at intervals ranging from 2 hours to 4 months after injection. In acute experiments (2 to 6 hours postinjection), blood was sometimes seen within the lumen of the central canal extending rostrally to the level of the fourth ventricle. Between 24 hours and 3 days, the parenchymal hematoma became consolidated and there was an intense proliferation of microglial cells at the perimeter of the lesion. The cells invaded the hematoma, infiltrated its core, and removed erythrocytes by phagocytosis. Rostral to the lesion, the lumen of the central canal was found to contain varying amounts of fibrin, proteinaceous material, and cellular debris for up to 15 days. These findings were much less prominent in the segments of the canal caudal to the lesion. Healing of the parenchymal hematoma was usually complete within 4 to 6 weeks except for residual hemosiderin-laden microglial cells and focal gliosis at the lesion site. It is concluded that the clearance of atraumatic hematomyelia probably involves two primary mechanisms: 1) phagocytosis of the focal hemorrhage by microglial cells; and 2) drainage of blood products in a rostral direction through the central canal of the spinal cord.

scholarly journals Thoracic Spinal Cord Herniation presenting with Brown-Sequard Syndrome

2001 ◽  
Vol 10 (6) ◽  
pp. 389-393
Author(s):  
Motohiro Kajiwara ◽  
Junya Hanakita ◽  
Hideyuki Suwa ◽  
Kazuhiko Shiokawa ◽  
Masaaki Saiki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation ◽  
Brown Sequard Syndrome

scholarly journals Upper thoracic spinal cord herniation after traumatic nerve root avulsion

2004 ◽  
Vol 16 (5) ◽  
pp. 306-309
Author(s):  
Victor R. DaSilva ◽  
Mubarak Al-Gahtany ◽  
Rajiv Midha ◽  
Dipanka Sarma ◽  
Perry Cooper
Keyword(s):  
Spinal Cord ◽  
Nerve Root ◽  
Signs And Symptoms ◽  
Root Avulsion ◽  
Thoracic Spinal Cord ◽  
First Case ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation ◽  
Nerve Root Avulsion ◽  
Upper Thoracic

✓ Transdural herniation of the spinal cord, a rare but well-documented entity, has been reported sporadically for more than 25 years as a possible cause for various neurological signs and symptoms ranging from isolated sensory or motor findings to myelopathy and Brown–Séquard syndrome. The authors report, to the best of their knowledge, the first case of upper thoracic spinal cord herniation occurring after traumatic nerve root avulsion.

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