Idiopathic spinal cord herniation: a new theory of pathogenesis

Najjar, Marwan; Baeesa, Saleh; Lingawi, Sattam S.

doi:10.1016/j.surneu.2003.10.030

Cited by 81 publications

(71 citation statements)

References 27 publications

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“…The results were consistent with the hypothesis of Najjar et al [19] and strongly hint that SCH was caused by the inflammation. Although further verification on the proposed mechanism by histological diagnosis study is not available in the present case, the history and clinical symptom of the current case were similar as the one reported by Baur et al [5].…”

Section: Discussionsupporting

confidence: 93%

“…It was well accepted that the presence of a dural defect is considered to be a necessary condition of SCH [17,18]. Najjar et al [19] proposed that an inflammation might lead to arachnoid adhesion formation and erosion through the dura forming an idiopathic dural defect and subsequent spinal cord herniation. The inflammation resulting from incarceration of the cord [20] may also cause the increased thickness of dorsal arachnoid [17,21,22].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Thoracic spinal cord herniation in a patient with long-standing ankylosing spondylitis

et al. 2010

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“…This did not reveal a statistically significant association between WDD and postoperative improvement in motor function (Fisher's exact test; P ϭ 0.173). However, when DS was removed from the analysis and only the treatment outcome of ADP was compared with that of WDD, the operative result was statistically significant and had a clinically relevant difference across the used operative technique (Fisher's exact test, P ϭ 0.036; Cohen's w ϭ 0.19) ( (56). Because the cause remains unknown, the rationale for a distinction between idiopathic or traumatic is missing.…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen patients were operated on twice because of a misdiagnosis (6,9,11,20,36,37,47,56,73,86,87). At the initial operation, a PAC was detected and was thought to be responsible for the neurological symptoms in 11 cases.…”

Section: Resultsmentioning

confidence: 99%

“…Relief of the strangulated spinal cord can be obtained by resecting the dural ring around the cord, which at the same time results in a widening of the dura defect and also prevents reherniation and restrangulation of the cord. A number of authors claim that this technique is safer and is associated with the best operative outcome because the cord manipulations that are needed when closing the ventral dura defect (directly or by means of some type of patch) can be avoided (35,56,69,86). Isu et al (35) state that the aim of the operation is to resolve the incarceration of the spinal cord.…”

Section: Neurosurgerymentioning

confidence: 99%

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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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