Atypical Clinical Presentation of Idiophatic Thoracic Spinal Cord Herniation

Şentürk, Senem; Güzel, Aslan; Güzel, Ebru

doi:10.1097/brs.0b013e318178e624

Cited by 18 publications

(18 citation statements)

References 16 publications

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“…Due to its rarity and atypical presentation, ISCH is a difficult clinical diagnosis and patients like those in this case series may experience a delay in diagnosis and treatment. 8, 9, 13, 14, 16, 17, 21 Although the etiology underlying ISCH has remained disputed, this series and prior reports 16, 33 continue to suggest that a trauma is a likely proximate cause of ISCH. Four patients in this series experienced severe traumatic injuries, one with a vertebral fracture at the level of ISCH and another with a nerve root avulsion injury.…”

Section: Discussionmentioning

confidence: 73%

“…18–20 The chronic atypical presentation and diagnostic challenge often leads to a delay in diagnosis and treatment. 8, 9, 13, 14, 16, 17, 21 There is little consensus on the management for asymptomatic ISCH 17 . However, the literature anecdotally supports surgical intervention in patients with ISCH and myelopathy symptoms that are not attributable to another cause.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

Symptomatic Thoracic Spinal Cord Herniation

Hawasli

Ray

Wright

2014

Operative Neurosurgery

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“…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].…”

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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“…1,2,17,23,37 In one of the largest series, Massicotte et al 23 reported on 8 patients, 4 of whom did not have surgery. These 4 patients were observed for up to 8 years after presentation and none developed progressive neurological symptoms.…”

Section: Surgery and Techniquesmentioning

confidence: 99%

“…Similarly, Ammar et al 2 reported on 2 patients who presented without weakness or spasticity and were followed for 15 months in one and 5 years in the other, without progression of symptoms. Senturk et al 37 followed a 38-year-old woman with progressive thoracic back pain without neurological deficits for 6 months without progression of symptoms. Hausmann and Moseley 17 reported on 2 patients who presented with spasticity and weakness, but did not undergo surgery.…”

Section: Surgery and Techniquesmentioning

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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Atypical Clinical Presentation of Idiophatic Thoracic Spinal Cord Herniation

Cited by 18 publications

References 16 publications

Symptomatic Thoracic Spinal Cord Herniation

Symptomatic Thoracic Spinal Cord Herniation

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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