Spinal cord herniation as a complication of en bloc, multilevel, anterior thoracic vertebrectomy for a giant cell tumor: success of posterior cord reduction and dural repair

2014 ◽  
Vol 21 (6) ◽  
pp. 909-912 ◽  
Author(s):  
Khandkar A. Kawsar ◽  
Robin Bhatia ◽  
Adrian C. T. H. Casey
Keyword(s):  
Spinal Cord ◽  
Neurological Deficit ◽  
Rare Complication ◽  
Dural Defect ◽  
En Bloc ◽  
Dural Repair ◽  
Spinal Stabilization ◽  
Spinal Cord Herniation ◽  
Original Procedure ◽  
Progressive Paraparesis

Iatrogenic spinal cord herniation is a rare complication following spinal stabilization surgery. The authors present a case of circumferential thoracic tumor decompression and fixation by anterior instrumentation complicated by delayed anterior spinal cord herniation. This complication resulted in progressive paraparesis 5 years after the original procedure. The patient underwent reexploration and repair of the dural defect, resulting in the reduction of the spinal cord to its normal position. The patient's paraparesis improved significantly after dural repair. Although progression of neurological deficit can be very slow, repair of the dural defect can restore normal spinal cord alignment and improve neurological deficit. To the best of the authors' knowledge, this is the first reported case of spinal cord herniation following an anterior thoracic vertebrectomy.

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.

scholarly journals Posterior Trans-Dural Repair of Iatrogenic Spinal Cord Herniation after Resection of Ossification of Posterior Longitudinal Ligament

2016 ◽  
Vol 10 (2) ◽  
pp. 355
Author(s):  
Seung-Jae Hyun ◽  
Hong-Ki Kim ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
Hyun-Jib Kim
Keyword(s):  
Spinal Cord ◽  
Posterior Longitudinal Ligament ◽  
Dural Repair ◽  
Spinal Cord Herniation

Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis?

2002 ◽  
Vol 97 (3) ◽  
pp. 369-374 ◽  
Author(s):  
Giuseppe M. V. Barbagallo ◽  
Laurence A. G. Marshman ◽  
Carl Hardwidge ◽  
Richard W. Gullan
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Prosthetic Material ◽  
Dural Defect ◽  
Content Type ◽  
Distinct Subgroup ◽  
Surgical Reduction ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Fine Print

✓ The authors present two cases of thoracic idiopathic spinal cord herniation (TISCH) occurring at the vertebral body (VB) level in whom adequate surgical reduction failed to reverse symptoms. In the second case, in which TISCH occurred into a VB cavity, presentation was atypical (subacute spinal cord syndrome) and there was persistent postoperative deterioration. In both cases, adequate surgical reduction was achieved via a posterior midthoracic laminectomy, and reduction was maintained by closure of the anterior dural defect by using prosthetic material. Thoracic idiopathic spinal cord herniation occurring at a VB level may be technically well treated by surgical reduction, but the outcome appears less predictable. Herniation that occurs directly into a VB cavity may form a distinct subgroup in which the presentation is atypical and the prognosis worse.

Idiopathic spinal cord herniation

1998 ◽  
Vol 88 (2) ◽  
pp. 331-335 ◽  
Author(s):  
Shigeru Miyake ◽  
Norihiko Tamaki ◽  
Tatsuya Nagashima ◽  
Hiromitsu Kurata ◽  
Takahiro Eguchi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Pulse Sequence ◽  
Dural Defect ◽  
Csf Flow ◽  
Gradual Improvement ◽  
Cine Mr ◽  
Endoscopic Observation ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

✓ The authors describe two occurrences of idiopathic spinal cord herniation, an entity that has been reported previously in only 11 cases. The patients described in this report presented in midlife with Brown—Séquard syndrome. Computerized tomography myelography and magnetic resonance (MR) imaging showed ventral displacement of the spinal cord with no apparent dorsal mass. Intraspinal cerebrospinal fluid (CSF) flow studies in which phase-contrast pulse sequence cine MR imaging was used displayed a normal pattern dorsal to the spinal cord. Percutaneous intrathecal endoscopic observation did not disclose dorsal intradural cysts, but ventral adhesions were seen between the spinal cord and the dura. Microsurgical intradural exploration revealed ventrolateral herniation of the cord and a ventral root through a dural defect into an epidural arachnoid cyst. The adhesions were released, the cord was repositioned intradurally, and the dural defect was patched. The patients showed gradual improvement postsurgery, as did most of the patients in the previously reported cases. The CSF flow and endoscopic studies were found to be particularly informative, and dural patching with surgical membrane is recommended.

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.

Spinal Cord Herniation

2005 ◽  
Vol 3 (6) ◽  
pp. 508-509
Author(s):  
Laurence Marshman
Keyword(s):  
Spinal Cord ◽  
Dura Mater ◽  
Posterior Approach ◽  
Direct Manipulation ◽  
Dural Repair ◽  
Content Type ◽  
Novel Approach ◽  
Spinal Cord Herniation ◽  
Thoracic Cord ◽  
Fine Print

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.

Idiopathic spinal cord herniation

1999 ◽  
Vol 7 (5) ◽  
pp. E8 ◽  
Author(s):  
Shigeru Miyake ◽  
Norihiko Tamaki ◽  
Tatsuya Nagashima ◽  
Hiromitsu Kurata ◽  
Takahiro Eguchi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Pulse Sequence ◽  
Dural Defect ◽  
Csf Flow ◽  
Gradual Improvement ◽  
Cine Mr ◽  
Endoscopic Observation ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

The authors describe two occurrences of idiopathic spinal cord herniation, an entity that has been reported previously in only 11 cases. The patients described in this report presented in midlife with Brown-Séquard syndrome. Computerized tomography myelography and magnetic resonance (MR) imaging showed ventral displacement of the spinal cord with no apparent dorsal mass. Intraspinal cerebrospinal fluid (CSF) flow studies in which phase-contrast pulse sequence cine MR imaging was used displayed a normal pattern dorsal to the spinal cord. Percutaneous intrathecal endoscopic observation did not disclose dorsal intradural cysts, but ventral adhesions were seen between the spinal cord and the dura. Microsurgical intradural exploration revealed ventrolateral herniation of the cord and a ventral root through a dural defect into an epidural arachnoid cyst. The adhesions were released, the cord was repositioned intradurally, and the dural defect was patched. The patients showed gradual improvement postsurgery, as did most of the patients in the previously reported cases. The CSF flow and endoscopic studies were found to be particularly informative, and dural patching with surgical membrane is recommended.

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.

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