Anterior spinal hernia: an increasingly recognised cause of thoracic cord dysfunction.

White, Barrie; Firth, J. L.

doi:10.1136/jnnp.57.11.1433

Cited by 54 publications

(34 citation statements)

References 3 publications

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“…In all cases the spinal cord was displaced anteriorly. Similarly, there was focal cord atrophy in 14-15 of 16 cases [1] (in 1 case there was disagreement about the presence of cord atrophy). T 2 hyperintensity within the affected cord was a common feature, present in 10 of 16 cases.…”

Section: Radiological Findingsmentioning

confidence: 95%

“…The cord prolapses through an anterior or anterolateral dural defect, resulting in a progressive, frequently asymmetrical, thoracic myelopathy. Patients typically present in middle age with slowly progressive neurological dysfunction relating to anterior hemicord dysfunction [1,2]. The condition was described in 1973 by Cobb et al [3], with the first idiopathic case suggested by Wortzman et al [4] a year later; a number of case reports and small series have been published since.…”

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confidence: 99%

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The thoracic anterior spinal cord adhesion syndrome

Taylor¹,

Dineen²,

White³

et al. 2012

BJR

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Objectives: This study included a series of middle-aged male and female patients who presented with chronic anterior hemicord dysfunction progressing to paraplegia. Imaging of anterior thoracic cord displacement by either a dural adhesion or a dural defect with associated cord herniation is presented. Methods: This is a retrospective review of cases referred to a tertiary neuroscience centre over a 19-year period. Imaging series were classified by two experienced neuroradiologists against several criteria and correlated with clinical examination and/ or findings at surgery. Results: 16 cases were available for full review. Nine were considered to represent adhesions (four confirmed surgically) and four to represent true herniation (three confirmed surgically). In the three remaining cases the diagnosis was radiologically uncertain. Conclusion:The authors propose ''thoracic anterior spinal cord adhesion syndrome'' as a novel term to describe this patient cohort and suggest appropriate clinicoradiological features for diagnosis. Several possible aetiologies are also suggested, with disc rupture and inflammation followed by disc resorption and dural pocket formation being a possible mechanism predisposing to herniation at the extreme end of a clinicopathological spectrum. Anterior spinal cord hernia is a rare and potentially treatable cause of progressive anterior spinal cord syndrome. The cord prolapses through an anterior or anterolateral dural defect, resulting in a progressive, frequently asymmetrical, thoracic myelopathy. Patients typically present in middle age with slowly progressive neurological dysfunction relating to anterior hemicord dysfunction [1, 2]. The condition was described in 1973 by Cobb et al [3], with the first idiopathic case suggested by Wortzman et al [4] a year later; a number of case reports and small series have been published since. The exact causative mechanism has not been fully elucidated. The radiological findings of true herniation are well described but not widely recognised as the number of cases in world literature remains relatively small.In our clinical practice we have identified a number of patients who present with a clinical picture that is indistinguishable from patients with anterior spinal cord herniation and MRI demonstration of anterior cord deviation, but without imaging or surgical evidence of a true cord hernia. Based on this observation, we suspect that true hernia is positioned at the extreme end of a pathological spectrum; other cases of anterior cord deviation and wasting-possibly caused by focal vulnerability, deficiency of the anterior dura or anterior tethering of the cord-appear to present with similar clinical symptoms. Evidence in support of this assertion is the case reported by Ewald et al [5] demonstrating progressive development of an anterolateral T6 cord herniation on successive MRI examinations, with associated progression in clinical symptoms over a 2-year period prior to operative intervention. We propose that the association of thoracic myelopat...

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Section: Radiological Findingsmentioning

confidence: 95%

mentioning

confidence: 99%

The thoracic anterior spinal cord adhesion syndrome

Taylor¹,

Dineen²,

White³

et al. 2012

BJR

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“…Najjar et al [19] proposed that an inflammation might lead to arachnoid adhesion formation and erosion through the dura forming an idiopathic dural defect and subsequent spinal cord herniation. The inflammation resulting from incarceration of the cord [20] may also cause the increased thickness of dorsal arachnoid [17,21,22]. In addition, within several mechanisms suggested as cause of nervous system involvement in AS, inflammation and compression are the main causative mechanisms [23,24].…”

Section: Discussionmentioning

confidence: 99%

Thoracic spinal cord herniation in a patient with long-standing ankylosing spondylitis

et al. 2010

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The objective of this study was to describe an adult male patient with ankylosing spondylitis (AS) associated with thoracic spinal cord herniation (TSCH). TSCH is a scarce entity presented as a displacement of thoracic cord through an anterior or anterolateral dural defect. More importantly, the co-occurrence of AS and thoracic spinal cord herniation is exceptional. To date, only one case of SCH in association with AS has been reported in the literature. A 56-year-old male patient presented with the progressive difficulty in walking and numbness of both lower limbs for the past 18 months. The patient was diagnosed as AS when he was 30 years old. Sagittal MRI of thoracic spine showed dural defect of the posterior aspect of T11 and 12 vertebral bodies. Axial T2-weighted MRI demonstrated that spinal cord was displaced ventrally and to the right. The diagnosis of TSCH with AS was established. The prognosis was explained to the patient. We recommended duraplasty for dural repair to the patient, but he refused surgery. The results demonstrated that TSCH associated with long-standing AS was very uncommon, and MRI is recommended to rule out SCH in the long-standing AS patients with neurologic symptoms. The SCH in AS might be caused by inflammation, and thoracolumbar hyperkyphosis results from AS might be associated with the development of SCH.

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“…Theories about this congenital defect include a preexisting ventral pseudomeningocele, a meningeal diverticulum, or an extradural arachnoid cyst. 47 Both Wortzman et al 48 and Masuzawa et al 24 suggested that herniation results from a congenital ventral meningocele. No other congenital bony spinal or neural deformities were reported in these cases.…”

Section: Pathogenesismentioning

confidence: 99%

“…47 This vascular mechanism may also explain the lack of improvement in some patients following untethering of the spinal cord.…”

Section: Pathophysiological Features Of Tetheringmentioning

confidence: 99%

Idiopathic ventral spinal cord herniation: a rare presentation of tethered cord

Shin¹,

Krishnaney²

2010

FOC

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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.

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Anterior spinal hernia: an increasingly recognised cause of thoracic cord dysfunction.

Cited by 54 publications

References 3 publications

The thoracic anterior spinal cord adhesion syndrome

The thoracic anterior spinal cord adhesion syndrome

Thoracic spinal cord herniation in a patient with long-standing ankylosing spondylitis

Idiopathic ventral spinal cord herniation: a rare presentation of tethered cord

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