Herniation of the spinal cord 38 years after childhood trauma

Urbach, Horst; Kaden, B.; Pechstein, U.; Solymosi, L.

doi:10.1007/bf00604806

Cited by 52 publications

(20 citation statements)

References 8 publications

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“…11,27 Sphincter dysfunction is frequently reported in association with TISCH. 9,11,16,20,21,24,25,27 A presentation, however, with a bilateral sensory level affecting all modalities and associated with paraparesis (as apparent in Case 2) has not been previously reported. Such a presentation therefore appears unique.…”

Section: Discussionmentioning

confidence: 78%

Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis?

Barbagallo

Marshman²,

Hardwidge³

et al. 2002

Journal of Neurosurgery: Spine

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✓ The authors present two cases of thoracic idiopathic spinal cord herniation (TISCH) occurring at the vertebral body (VB) level in whom adequate surgical reduction failed to reverse symptoms. In the second case, in which TISCH occurred into a VB cavity, presentation was atypical (subacute spinal cord syndrome) and there was persistent postoperative deterioration. In both cases, adequate surgical reduction was achieved via a posterior midthoracic laminectomy, and reduction was maintained by closure of the anterior dural defect by using prosthetic material. Thoracic idiopathic spinal cord herniation occurring at a VB level may be technically well treated by surgical reduction, but the outcome appears less predictable. Herniation that occurs directly into a VB cavity may form a distinct subgroup in which the presentation is atypical and the prognosis worse.

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Section: Discussionmentioning

confidence: 78%

Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis?

Barbagallo

Marshman²,

Hardwidge³

et al. 2002

Journal of Neurosurgery: Spine

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“…After exclusion of cases with negative exploration (13,80), cord biopsy (16,32,42,48,72,91), absence of preoperative motor deficit (16,46,79,81), arachnoid cyst removal without CR (21,35,75,83), and unknown postoperative results (21,75,83), a sample of 111 patients was available for multivariable logistic regression to identify sociodemographic and clinical characteristics, operative findings, and surgical techniques as determinants of postoperative motor function improvement. Adjusted for age, gender, operative interval, and vertebral seg-sample of patients with ATSCH who were described in sufficient detail in case reports that were published in international scientific medical journals.…”

Section: Resultsmentioning

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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“…A number of mechanisms leading to spinal cord herniation have been described by other authors, including congenital anterior dural defects or duplication [8][9][10][11], and trauma is specifically implicated in certain cases [12][13][14], although the onset of symptoms is often delayed with at least one reported case of onset of clinical symptoms many years after the initial traumatic event [15]. Several authors have also postulated that there may be a common underlying aetiology between arachnoid cyst and cord hernia, with examples of coexistent cyst and ventral deviation of the thoracic cord [16,17].…”

Section: Discussionmentioning

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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Herniation of the spinal cord 38 years after childhood trauma

Cited by 52 publications

References 8 publications

Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis?

Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis?

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

The thoracic anterior spinal cord adhesion syndrome

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