scholarly journals Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case

2021 ◽  
Vol 2 (8) ◽  
Author(s):  
Ikenna Ogbu ◽  
Mohamed Eltoukhy ◽  
Nikolaos Tzerakis

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.

2004 ◽  
Vol 16 (5) ◽  
pp. 306-309
Author(s):  
Victor R. DaSilva ◽  
Mubarak Al-Gahtany ◽  
Rajiv Midha ◽  
Dipanka Sarma ◽  
Perry Cooper

✓ 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.


2003 ◽  
Vol 99 (3) ◽  
pp. 306-309 ◽  
Author(s):  
Victor R. Dasilva ◽  
Mubarak Al-Gahtany ◽  
Rajiv Midha ◽  
Dipanka Sarma ◽  
Perry Cooper

✓ 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.


2009 ◽  
Vol 57 (2) ◽  
pp. 221 ◽  
Author(s):  
ShashankS Kale ◽  
BhavaniS Sharma ◽  
NarayanamA Sai Kiran ◽  
Sandeep Vaishya ◽  
ManishK Kasliwal

2010 ◽  
Vol 29 (1) ◽  
pp. E10 ◽  
Author(s):  
John H. Shin ◽  
Ajit A. Krishnaney

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.


Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 278-278
Author(s):  
Shashank V Gandhi ◽  
Ahmad Latefi

Abstract INTRODUCTION Detethering of the spinal cord has historically been the treatment of choice for TCS in the setting of spinal dysraphisms. Recurrent TCS occurs 5–80% of patients. Risk of neurological injury, CSF leak, and wound breakdown increase with subsequent procedures. Kokubun et al. described using PVCSO without microsurgical detethering to relieve stretch strain on the spinal cord; however, there is a paucity of literature on its success. Here we describe our experience with PVCSO for TCS. METHODS A prospectively collected database patients with TCS who underwent PVCSO or were being monitored for potential surgery was analyzed. A team of two neurosurgeons evaluated each patient for potential benefit from spinal shortening osteotomies. Preoperative evaluation included MRI and upright radiographs to assess for location and type of tethering and presence of deformity. Single stage posterior PVCSO were conducted at a neutral level rostral to the tethering site, shortening by 10–15mm. When present PVCSOs were concurrently utilized to correct deformities. RESULTS >6 patients were assessed. 4 patients had failed previous microsurgical detethering at least once. 4 patients underwent PVCSO due to worsening of symptoms: 2 with history of myelomeningocele repair and 2 with arachnoid adhesions after spinal subdural hematoma. All 4 had resolution of weakness, numbness, and radicular pain of legs. Incontinence improved in the patient with arachnoid adhesions. There was no worsening of neurological function. 1 patient with spinal cord herniation and scoliosis, had improved radiculopathy from detethering. CONCLUSION In this series all patients who underwent PVCSO for TCS experiences improvement in motor, sensory, and pain symptoms. Indirect relief of in-line strain and stretch on the spinal cord is possible through PVCSO by shortening the spinal column, without high risk of recurrence of symptoms or neurological injury as there is no direct manipulation of neural elements. PVCSO can be utilized for both congenital and acquired TCS.


2021 ◽  
Author(s):  
jinxing li ◽  
Toru Sasamori ◽  
Kazutoshi Hida

Abstract This 68-year-old man presented with progressive spastic paraparesis of 2-month duration. The diagnosis was Brown-Sequard syndrome(BSS). Magnetic resonance imaging (MRI) revealed ventral displacement of the spinal cord at Th 7–8. The spinal cord deformity was dominant on the left side. He underwent surgery under the preoperative diagnosis of spinal cord herniation at Th 7–8. Intraoperatively we detected an arachnoid cyst and an osteophyte that compressed the spinal cord at Th 7–8 dorsally and ventrally rather than spinal cord herniation. Postoperative MRI showed successful spinal cord decompression. His neurological findings improved remarkably just after surgery. Although the misdiagnosis of spinal hernia in the actual presence of arachnoid cysts has been reported, ours is the first case of both, a lateralized osteophyte and an arachnoid cysts mimicking spinal cord herniation.


2021 ◽  
Vol 2 (14) ◽  
Author(s):  
Yasufumi Ohtake ◽  
Makoto Senoo ◽  
Mamoru Fukuda ◽  
Yuuki Ishida ◽  
Ryunosuke Yoshihara ◽  
...  

BACKGROUND Idiopathic spinal cord herniation (ISCH) is very rare. Some reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH; however, such collections are asymptomatic in most patients, and there is no consensus regarding whether they are part of the natural history or a complication. OBSERVATIONS A 30-year-old man with ISCH underwent direct closure of a duplicated dura mater. Eight months postoperatively, he developed reworsening of right lower limb paresis and new severe right arm pain and paresis. Three-dimensional magnetic resonance imaging revealed ventral CSF collections, which the authors judged as the responsible lesions. The authors initially considered these collections to be present in the epidural space, extradurally compressing the dural sac and resulting in myelopathy. An epidural blood patch failed; however, a CSF drainage test resulted in dramatic improvement. The authors therefore determined that the CSF collections were located in the interdural space, not the epidural space. A lumboperitoneal (LP) shunt was performed to reduce the CSF pressure. The patient’s symptoms improved immediately postoperatively. He had developed no recurrence of symptoms 6 months after surgery. LESSONS Ventral interdural CSF collections after ISCH surgery can cause reworsening of myelopathy and may be cured by a LP shunt to control CSF pressure.


2021 ◽  
Vol 2 (19) ◽  
Author(s):  
Zirun Zhao ◽  
Saman Shabani ◽  
Nitin Agarwal ◽  
Praveen V. Mummaneni ◽  
Dean Chou

BACKGROUND A three-column osteotomy results in dural buckling, which may appear concerning upon intraoperative visualization because it may appear that the neural elements may also be buckled. The authors presented an intraoperative view after intentional durotomy of the neural elements and the relaxed state of the dura after three-column osteotomy. OBSERVATIONS A 52-year-old woman with adult tethered cord syndrome and previous untethering presented with worsening leg pain and stiffness, urinary incontinence, and unbalanced gait. Magnetic resonance imaging demonstrated an arachnoid web at T6 and spinal cord tethering. Spinal column shortening via three-column osteotomy was performed with concomitant intradural excision of the arachnoid web. Dural buckling was observed intraoperatively after spinal column shortening. After the durotomy, the spinal cord was visualized without kinking or buckling. LESSONS Dural buckling after spinal column shortening of 15 mm via three-column osteotomy at T6 did not result in concomitant buckling of the underlying neural elements.


Author(s):  
Haruki Funao ◽  
Satoshi Nakamura ◽  
Kenshi Daimon ◽  
Norihiro Isogai ◽  
Yutaka Sasao ◽  
...  

2012 ◽  
Vol 312 (1-2) ◽  
pp. 170-172 ◽  
Author(s):  
Giorgio B. Boncoraglio ◽  
Elena Ballabio ◽  
Alessandra Erbetta ◽  
Francesco Prada ◽  
Mario Savoiardo ◽  
...  

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