Idiopathic spinal cord herniation at two separate zones of the thoracic spine: the first reported case and literature review

Aydın, Ahmet Levent; Sasani, Mehdi; Erhan, Belgin; Sasani, Hadi; Özcan, Seda Sabah; Özer, Ali Fahir

doi:10.1016/j.spinee.2011.07.003

Cited by 26 publications

(35 citation statements)

References 41 publications

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“…Spinal cord herniation is probably a more frequent cause of myelopathy than what is currently diagnosed. 5,6 Due to the rarity and the atypical presentation of spinal cord herniation, its diagnosis and treatment may be delayed. 7,8 The presence of a dural defect is the primary pathophysiological factor in the development of this condition, but its etiology remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 The presence of a dural defect is the primary pathophysiological factor in the development of this condition, but its etiology remains unknown. 5 This defect in the dura mater can occur at more than one point and cause herniation of two sites. 5 It is believed that the trauma may be related to hernia formation, a fact not shown in this case.…”

Section: Discussionmentioning

confidence: 99%

“…5 This defect in the dura mater can occur at more than one point and cause herniation of two sites. 5 It is believed that the trauma may be related to hernia formation, a fact not shown in this case. 8 The definitive diagnosis is obtained by imaging examinations.…”

Section: Discussionmentioning

confidence: 99%

“…However, the exact cause of the dural defect remains unknown. 5 There is no consensus in the literature about a diagnostic algorithm and surgical treatment, nor is there any clinical evolution data.…”

Section: Introductionmentioning

confidence: 99%

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Idiopathic Spinal Cord Herniation—Case Report

et al. 2016

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Palavras-Chave► doenças da medula espinal ► síndrome de BrownSéquard ► mielografia ► ressonância magnética ► hérnia ► cirurgia ResumoHerniação medular idiopática é uma causa rara de mielopatia progressiva, especialmente na ausência de história clínica de trauma raquimedular ou cirúrgico. O diagnóstico radiológico é feito por meio de mielotomografia ou ressonância magné-tica. A medula espinal é deslocada anteriormente, tamponando o defeito dural e levando na maioria dos casos a uma síndrome de Brown-Séquard. O presente estudo demonstra o caso de um paciente do sexo masculino com quadro clínico de mielopatia torácica progressiva. Na investigação clínica e radiológica, foi identificada uma herniação medular idiopática ao nível torácico. Durante a cirurgia, a medula espinal foi reduzida ao local natural, tomando sua forma elíptica habitual, e a falha dural foi reparada com substituto dural. O paciente melhorou da dormência, e houve desaparecimento dos choques nos membros inferiores. A ressonância pós-operatória confirmou a redução cirúrgica da herniação e o restabelecimento de coluna liquórica anterior à medula espinal. Os autores descreveram os achados clínicos, radiológicos e intraoperatórios, bem como a evolução pós-operatória. AbstractIdiopathic spinal cord herniation is a rare cause of progressive myelopathy, especially in the absence of a history of spinal or surgical trauma. Myelography or MRI makes the radiological diagnosis. The spinal cord is pushed anteriorly, buffering the dural defect and leading in most cases to Brown-Séquard syndrome. This study demonstrates the case of a male patient with clinical picture of progressive thoracic myelopathy. In clinical and radiological investigation was identified idiopathic spinal cord herniation to the chest level. During surgery, the spinal cord was reduced to the natural site, taking his usual elliptical shape, and the dural defect was repaired with dural substitute. The patient improved the numbness and shock disappearance of the lower limbs. Postoperative resonance confirms the surgical reduction of herniation and restoring previous CSF column to the spinal cord. The authors described the clinical, radiological, intraoperative, and postoperative evolution.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Idiopathic Spinal Cord Herniation—Case Report

et al. 2016

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“…Some report rapid improvement for all patients while others paint a more conservative prognosis. 2, 5–8, 10, 12, 16, 21, 22, 29–32 In this manuscript, we review the Washington University School of Medicine experience with ISCH and report the unusual presentations of the myelopathy, history of remote trauma, imaging progression over time, operative pearls and technique (with an instructional video) and clinical outcomes.…”

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confidence: 99%

Symptomatic Thoracic Spinal Cord Herniation

Hawasli

Ray

Wright

2014

Operative Neurosurgery

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Background and Importance Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on treatment algorithm and surgical technique, and there is little data on clinical outcomes. Clinical Presentation In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially due to multiple sclerosis. Finally compared to compressive myelopathy in the thoracic spine, surgical treatment of ISH led to rapid improvement despite long duration of symptoms. Conclusion Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

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