Dorsal thoracic spinal cord herniation: report of an unusual case and review of the literature

Le, Thanh; Grunch, Betsy H.; Karikari, Isaac O.; Mehta, Ankit I.; Owens, Timothy R.; Gottfried, Oren N.; Bagley, Carlos A.

doi:10.1016/j.spinee.2012.09.039

Cited by 20 publications

(23 citation statements)

References 15 publications

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“…The thoracic localization of SCH might simply be related to the length and weight carried by the thoracic spine. The fascinating The most accepted theory of SCH-supported by intraoperative observations-is that there would be a defect (posttraumatic or congenital) on the anterior aspect of the dural and arachnoideal membranes, allowing the spinal cord to get nipped and/or protrude out of the dural sac [26][27][28]. Ewald et al, [29] have forwarded a proposition on the preexisting weakness of the ventral dural fibers combined with abnormal adhesion of the spinal cord to the anterior dural sleeve, leading progressively to herniation.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Herniation: Why Anterior Thoracic?

Szücs¹,

Horváth²,

Várallyay³

2015

J Neurol Neurosci

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Background: Spinal cord herniation and thoracic anterior adhesion syndrome make up the two extremes of a rare condition; characterized by anterior dural adhesion or protrusion of the spinal cord through the arachnoideal and dural membrane into the extradural space, respectively. Summary:We present the main features of the condition by our case series and forward a hypothesis for the consistent anterior, mid-thoracic localization. We surmise the role of an anterior pulling force by the Hofmann (meningo-vertebral) ligaments; acting when the physiologic thoracic kyphosis suddenly increases. The traction may tear the anterior dura; resulting in a dural defect; it allows the nipping/ protrusion of the spinal cord. Key messages:Because the spinal cord compression syndrome caused by adhesion or herniation of the spinal cord may be surgically treatable; the recognition of the condition is essential. The pathogenetic traction effect of the Hofmann ligament in the affected level may have surgical an prognostic implications.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Herniation: Why Anterior Thoracic?

Szücs¹,

Horváth²,

Várallyay³

2015

J Neurol Neurosci

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“…Usually SCH occurs between the T4 and T7 levels through a dural defect located ventrally, ventrolaterally, 3 or, more rarely, dorsally. 4 Tethered cord syndrome, consequent to SCH, is a stretch-induced functional disorder of the spinal cord due to mechanical compression and to the impaired blood flow in stretched cord. This can cause back pain radiating to the lower limbs as well as sensory and motor deficits.…”

Section: Discussionmentioning

confidence: 99%

Clinical Reasoning: A case of slowly progressive painful paraparesis

et al. 2014

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In 2003, a 50-year-old woman was admitted to the emergency department of a large hospital for a 2-month history of stabbing epigastric pain radiating backward to the right scapula. The pain was not relieved in any position and was not preceded by fever or trauma. Her history was unremarkable. General examination including temperature, pulse, and blood pressure was normal.Acute epigastric pain may have different nonneurologic etiologies including gastric, biliary, and pancreatic disorders. To rule out gastric disorders, a gastroscopy was performed. Gastroscopy revealed mild erythema of the gastric mucosa, but the histologic examination and studies for Helicobacter pylori were negative. The complete blood count as well as hepatic, pancreatic, and renal function were normal. Abdominal CT scan was normal. Ultrasonography of the right upper quadrant of the abdomen revealed no evidence of gallstones or cholecystitis. Dilation of the biliary and pancreatic ducts was ruled out by magnetic resonance cholangiopancreatography.The patient was discharged with diagnosis of "gallbladder hypokinesia" and pain slowly decreased over the following 2 years. In 2005, the patient demonstrated slowly progressive perineal and lumbar pain radiating to the left leg.Question for consideration:1. What investigations would you propose for this patient? SECTION 2Radicular pain along the leg can be related to disc herniation. Slipped discs occur more often in men aged between 30 and 55 years. The lumbar segment is more commonly affected followed by the cervical and thoracic segments. MRI is the gold standard in diagnosis of disc herniation. The patient underwent lumbosacral MRI, which revealed disc herniation between the fourth and fifth lumbar vertebrae. In order to evaluate the involvement of the spinal roots at this level, an EMG study was performed. The test revealed minimal chronic neurogenic signsnamely, high-amplitude rapidly firing motor unit potentials without fibrillation potentials-in muscles supplied by the fourth lumbar root. Subsequently, the pain was complicated by left lower limb spasticity; because of these symptoms, L4-L5 laminectomy and flavotomy were performed in 2007. The surgical intervention did not produce any benefit. She progressively worsened over the course of the following years and developed progressive gait disturbance with multiple falls, perineal and left lower limb hypoesthesia, and right lower limb spasticity. She also reported mild urinary retention. In 2012, neurologic examination revealed mild spastic paraparesis, hypoesthesia with upper level at T6, hyperreflexia in both lower limbs associated with bilateral clonus, and left Babinski sign. The cranial nerve and upper limb examination was normal.Questions for consideration:

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“…4,10,11,14 Two main approaches have been reported: either to closure of the defect itself or, conversely, to widen the dural defect to prevent strangulation. 1,2,4,8,11,13,14 Closure of the defect can be achieved by direct suture or by inserting a ventral patch, with or without glue, once the cord hernia is relocated to its anatomical position. 1,4,8,11,13,14 However, choosing the best technique remains a matter of debate.…”

Section: Fig 1 Preoperative Axial (Inset) and Sagittal T2-weighted mentioning

confidence: 99%

“…1,2,4,8,11,13,14 Closure of the defect can be achieved by direct suture or by inserting a ventral patch, with or without glue, once the cord hernia is relocated to its anatomical position. 1,4,8,11,13,14 However, choosing the best technique remains a matter of debate. Tekkök highlighted the fact that, since the space in which to perform direct suturing under the cord is minimal, attempts to do so may lead to an increased risk of neurological deterioration.…”

Section: Fig 1 Preoperative Axial (Inset) and Sagittal T2-weighted mentioning

confidence: 99%

Spinal cord herniation repair with microstaples: case report

Delgado-López¹,

Gil‐Polo²,

Martín-Velasco³

et al. 2017

SPI

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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.

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Dorsal thoracic spinal cord herniation: report of an unusual case and review of the literature

Cited by 20 publications

References 15 publications

Spinal Cord Herniation: Why Anterior Thoracic?

Spinal Cord Herniation: Why Anterior Thoracic?

Clinical Reasoning: A case of slowly progressive painful paraparesis

Spinal cord herniation repair with microstaples: case report

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