Idiopathic anterior spinal cord hernia: under-recognized cause of thoracic myelopathy

White, Barrie; Tsegaye, Magnum

doi:10.1080/02688690410001732670

Cited by 31 publications

(22 citation statements)

References 3 publications

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“…Furthermore, the diagnosis of TSCH may be delayed because of its nonspecific clinical features. Regarding the patient reported here, the history of longlasting AS, but fast progression of neurological deficits within a short period, was similar to that of TSCH reported although the clinical manifestation was atypical (paralysis and paraparesis) in contrast with typical ISCH (BrownSéquard syndrome) [9,10].…”

Section: Discussionsupporting

confidence: 74%

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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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Section: Discussionsupporting

confidence: 74%

“…It has been shown the TSCH patients were initially asymptomatic [8]. In addition, these symptoms typically are long lasting before the precise diagnosis [9,10]. In the literature, most of the patients typically present with Brown-Séquard syndrome [11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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“…At least half of the cases in their early stages manifested classical anterior hemicord features of stiffness in one leg and pain/temperature sensory disturbance in the other, but preserved proprioception in both, followed by progressive sensorimotor disturbance progressing towards paraplegia over several years [6]. Several cases presented with less typical constellations of symptoms, including bilateral lower limb motor weakness, myoclonic episodes and focal position-related radicular pain.…”

Section: Case Reviewmentioning

confidence: 99%

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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“…To prevent reherniation/reincarceration of the spinal cord, enlargement of the ventral dura defect has been promoted by several authors (49,51,58,61,68,76,85,86). Others strongly advocate closure of the defect by direct suturing (15,34,42,86,89) or by insertion of a patch (8, 10, 17, 22, 24, 25, 43-45, 47, 48, 52, 53, 55, 56, 72, 78, 79). However, the literature has not provided evidence in favor of any of these strategies from either controlled studies or meta-analysis.…”

Section: Groen Et Almentioning

confidence: 99%

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Groen

Middel

Meilof

et al. 2009

Operative Neurosurgery

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Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS: Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P Ͻ 0.036). CONCLUSION: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder.

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Idiopathic anterior spinal cord hernia: under-recognized cause of thoracic myelopathy

Cited by 31 publications

References 3 publications

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

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

The thoracic anterior spinal cord adhesion syndrome

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

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