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.

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.

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.

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.

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.

Somatosensory evoked potential monitoring in anterior thoracic vertebrectomy

2000 ◽  
Vol 92 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Harel Deutsch ◽  
Marc Arginteanu ◽  
Karen Manhart ◽  
Noel Perin ◽  
Martin Camins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Evoked Potential ◽  
False Negative ◽  
False Negative Rate ◽  
Neurological Deterioration ◽  
Somatosensory Evoked Potential ◽  
Content Type ◽  
Spinal Cord Function ◽  
Fine Print

Object. Spine surgeons have used intraoperative cortical and subcortical somatosensory evoked potential (SSEP) monitoring to detect changes in spinal cord function when intraoperative procedures can be performed to prevent neurological deterioration. However, the reliability of SSEP monitoring as applied to anterior thoracic vertebral body resections has not been rigorously assessed. Methods. The authors retrospectively reviewed hospital charts and operating room records obtained between August 1993 and December 1998 and found that SSEP monitoring was used in 44 surgical procedures involving an anterior approach for thoracic vertebral body resections. There were no patients in whom SSEP changes did not return to baseline during the surgical procedure. Patients in four cases, despite their stable SSEP recordings throughout the procedure, were noted immediately postoperatively to have experienced significant neurological deterioration. The false-negative rate in SSEP monitoring was 9%. Sensitivity was determined to be 0%. Conclusions. It is important to recognize high false-negative rates and low sensitivity of SSEP monitoring when it is used to record spinal cord function during anterior approaches for thoracic vertebrectomies. The insensitivity of SSEPs for motor deterioration during anterior thoracic vertebrectomies is likely due to the limitation of SSEPs, which monitor only posterior column function whereas motor paths are conveyed in the anterior and anterolateral spinal cord. The authors believe that SSEPs can not be relied on to detect reversible spinal damage during anterior thoracic vertebrectomies.

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.

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