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.

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.

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.

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.

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.

The value of intraoperative motor evoked potential monitoring during surgical intervention for thoracic idiopathic spinal cord herniation

2012 ◽  
Vol 16 (2) ◽  
pp. 114-126 ◽  
Author(s):  
Klaus Novak ◽  
Georg Widhalm ◽  
Adauri Bueno de Camargo ◽  
Noel Perin ◽  
George Jallo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Surgical Repair ◽  
Motor Evoked Potential ◽  
Motor Deficit ◽  
Dural Defect ◽  
Spinal Cord Herniation ◽  
Dural Graft ◽  
Evoked Potential Monitoring ◽  
Idiopathic Spinal Cord Herniation

Object Thoracic idiopathic spinal cord herniation (TISCH) is a rare neurological disorder characterized by an incarceration of the spinal cord at the site of a ventral dural defect. The disorder is associated with clinical signs of progressive thoracic myelopathy. Surgery can withhold the natural clinical course, but surgical repair of the dural defect bears a significant risk of additional postoperative motor deficits, including permanent paraplegia. Intraoperative online information about the functional integrity of the spinal cord and warning signs about acute functional impairment of motor pathways could contribute to a lower risk of permanent postoperative motor deficit. Motor evoked potential (MEP) monitoring can instantly and reliably detect dysfunction of motor pathways in the spinal cord. The authors have applied MEPs during intraoperative neurophysiological monitoring (IOM) for surgical repair of TISCH and have correlated the results of IOM with its influence on the surgical procedure and with the functional postoperative outcome. Methods The authors retrospectively reviewed the intraoperative neurophysiological data and clinical records of 4 patients who underwent surgical treatment for TISCH in 3 institutions where IOM, including somatosensory evoked potentials and MEPs, is routinely used for spinal cord surgery. In all 4 patients the spinal cord was reduced from a posterior approach and the dural defect was repaired using a dural graft. Results Motor evoked potential monitoring was feasible in all patients. Significant intraoperative changes of MEPs were observed in 2 patients. The changes were detected within seconds after manipulation of the spinal cord. Monitoring of MEPs led to immediate revision of the placement of the dural graft in one case and to temporary cessation of the release of the incarcerated spinal cord in the other. Changes occurred selectively in MEPs and were reversible. In both patients, transient changes in intraoperative MEPs correlated with a reversible postoperative motor deficit. Patients without significant changes in somatosensory evoked potentials and MEPs demonstrated no additional neurological deficit postoperatively and showed improvement of motor function during follow-up. Conclusions Surgical repair of the dural defect is effected by release and reduction of the spinal cord and insertion of dural substitute over the dural defect. Careful monitoring of the functional integrity of spinal cord long tracts during surgical manipulation of the cord can detect surgically induced impairment. The authors' documentation of acute loss of MEPs that correlated with reversible postoperative motor deficit substantiates the necessity of IOM including continuous monitoring of MEPs for the surgical treatment of TISCH.

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.

scholarly journals Idiopathic Spinal Cord Herniation—Case Report

2016 ◽  
Vol 37 (03) ◽  
pp. 280-283
Author(s):  
Rogerio Sacco ◽  
Ricardo Gepp ◽  
Marco Quiroga ◽  
Henrique Souza ◽  
Vitor Aguiar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Lower Limbs ◽  
Surgical Trauma ◽  
Dural Defect ◽  
Thoracic Myelopathy ◽  
Radiological Investigation ◽  
Postoperative Mri ◽  
Spinal Cord Herniation ◽  
History Of ◽  
Idiopathic Spinal Cord Herniation

AbstractIdiopathic spinal cord herniation is a rare cause of progressive myelopathy, especially in the absence of a history of spinal or surgical trauma. The radiological diagnosis is made through a myelography or an MRI exam. The spinal cord is pushed anteriorly, buffering the dural defect and leading in most cases to Brown-Séquard syndrome. The present study describes the case of a male patient with a clinical picture of progressive thoracic myelopathy. In the clinical and radiological investigation, an idiopathic spinal cord herniation on the chest level was identified. During the surgery, the spinal cord was reduced to the natural site, taking its usual elliptical shape, and the dural defect was repaired with a dural substitute. The numbness of the patient improved, and the shocks in the lower limbs disappeared. A postoperative MRI confirmed the surgical reduction of the herniation and the restoration of the anterior cerebrospinal fluid (CSF) column to the spinal cord. The authors describe the clinical, radiological, intraoperative, and postoperative evolution.

Image classification of idiopathic spinal cord herniation based on symptom severity and surgical outcome: a multicenter study

2009 ◽  
Vol 11 (3) ◽  
pp. 310-319 ◽  
Author(s):  
Shiro Imagama ◽  
Yukihiro Matsuyama ◽  
Yoshihito Sakai ◽  
Hiroshi Nakamura ◽  
Yoshito Katayama ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Bone Defect ◽  
Surgical Outcome ◽  
Postoperative Recovery ◽  
Ct Myelography ◽  
Spinal Cord Herniation ◽  
Type C ◽  
Idiopathic Spinal Cord Herniation

Object The purpose of this study was to provide the first evidence for image classification of idiopathic spinal cord herniation (ISCH) in a multicenter study. Methods Twelve patients who underwent surgery for ISCH were identified, and preoperative symptoms, severity of paralysis and myelopathy, disease duration, plain radiographs, MR imaging and CT myelography findings, surgical procedure, intraoperative findings, data from spinal cord monitoring, and postoperative recovery were investigated in these patients. Findings on sagittal MR imaging and CT myelography were classified into 3 types: a kink type (Type K), a discontinuous type (Type D), and a protrusion type (Type P). Using axial images, the location of the hiatus was classified as either central (Type C) or lateral (Type L), and the laterality of the herniated spinal cord was classified based on correspondence (same; Type S) or noncorrespondence (opposite; Type O) with the hiatus location. A bone defect at the ISCH site and the laterality of the defect were also noted. Results Patients with Type P herniation had a good postoperative recovery, and those with a Type C location had significant severe preoperative lower-extremity paralysis and a significantly poor postoperative recovery. Patients with a bone defect had a significantly severe preoperative myelopathy, but showed no difference in postoperative recovery. Conclusions The authors' results showed that a Type C classification and a bone defect have strong relationships with severity of symptoms and surgical outcome and are important imaging and clinical features for ISCH. These findings may allow surgeons to determine the severity of preoperative symptoms and the probable surgical outcome from imaging.

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.

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