Spinal cord herniation repair with microstaples: case report

Abstract

<jats:p>Idiopathic spinal cord herniation (ISCH) is a relatively rare and frequently misdiagnosed condition. It preferentially affects women and causes progressive thoracic myelopathy that presents as a Brown-Séquard syndrome or as spastic paraparesis. Although its etiology and pathogenesis are controversial, ISCH is characterized by the presence of an anterior dural defect that allows the incarceration of a segment of the cord. Typically, a C-shaped ventral displacement and kinking of the cord are visible on sagittal MRI. Surgery aimed at stopping or reversing myelopathic symptoms is usually recommended for symptomatic patients. Surgical options include reduction of the hernia and direct suturing, or enlargement of the dural defect, with or without patching. Suturing under the cord in a very tight space can be troublesome and may lead to neurological deterioration. The authors present the case of a symptomatic ISCH in which nonpenetrating titanium microstaples were used to close the dural defect after cord reduction. The patient experienced a good outcome, and the follow-up MRI study showed adequate cord repositioning and stability of the suture. The use of microstaples, which allows for an easier and faster dural closure than conventional suturing, is a novel technical adjunct that has not been previously reported for this condition. In addition, microstaples produce minimal metallic artifact that does not hinder the quality of follow-up MR images.</jats:p>

Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review

“…We reviewed cases of BSS caused by thoracic vertebral pathologies and their treatments reported from 1978 to 2021 14 – 44 ( Table 1 ). Among these 50 cases, the age at presentation ranged from 11 to 76 years (average, 45.9 years).…”

Thoracic ventral spinal cord herniation with progressive myelopathy – A case report and review of the literature

“…Conversely, duraplasty minimizes the risk of inadvertent spinal cord manipulation and the related postoperative neurological dysfunction, but introduces a foreign material into the patient. [ 4 , 10 , 12 ]…”

“…It involves anterior or anterolateral displacement of spinal cord tissue through a small, ventral dural defect most typically arising in the upper/mid thoracic spine between the T2-T8 levels. [ 4 , 12 ] There are fewer than 200 such cases described in the literature. As the diagnosis of ISCH is often delayed, many patients undergo progressive irreversible neurological deterioration before diagnostic studies confirming the diagnosis and before definitive appropriate surgery.…”

Thoracic anterior spinal cord herniation: treatment and prognosis outcome of 7 patients and review of the literature

“…Watanabe et al [39] used curved scissors to widen the dural defect and observed no recurrence during follow-up. Delgado-López et al [50] found that excessive tension between defect edges could lead to suture loosening, necessitating the innovative use of special vascular clips to complete this procedure. Furthermore, Kasliwal et al [51] used the paramedian approach of laminectomy and unilateral pedicle resection for the rst time in a patient with a spinal cord herniation.…”