Spinal cord herniation: Management and outcome in a series of 12 consecutives patients and review of the literature

Prada, Francesco; Saladino, Andrea; Giombini, S.; Erbetta, Alessandra; Saini, Marco; DiMeco, Francesco; Lodrini, S.

doi:10.1007/s00701-011-1265-1

Cited by 34 publications

(37 citation statements)

References 43 publications

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“…The most frequent misinterpretation is as a dorsal arachnoid cyst[145678101112131415161718192021232425] previously reported as a false diagnosis in around 45% of cases,[7980] but it has been reported that an associated dorsal arachnoid cyst is potentially present in 20-25% of patients with ISCH. [7980] Other misdiagnoses include thoracic disc herniation,[1213] transverse myelitis,[914] arachnoiditis,[4] intradural mass,[9] and extradural compressive lesion.…”

Section: Discussionmentioning

confidence: 99%

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Idiopathic spinal cord herniation: Clinical review and report of three cases

et al. 2013

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Idiopathic spinal cord herniation (ISCH) is a rare condition, of unknown pathogenesis, that primarily affects the thoracic spinal cord. It is characterized by ventral displacement of the spinal cord through a dural defect. The aim of this study was to review the literature and to present a retrospective single center experience with three cases of ISCH. The literature review analyzed a total of 78 relevant publications on ISCH, which included a total of 171 patients, supplemented with 3 patients treated at our institution. Numerous case reports have demonstrated improvement in clinical outcomes after surgery; however, follow-up is predominantly short, data are incomplete, the condition is frequently misdiagnosed, and it is difficult to predict which patients will benefit from surgery. We identified 159 cases treated with surgical management. The mean symptom duration was 54 months, and the mean follow-up 33 months. The result at follow-up was improved neurological outcome in 74%, unchanged result in 18%, and worse outcome in 8%. There were 15 cases of conservative management, with mean symptom duration 52 months and mean follow-up 33 months. The neurological outcome was unchanged in 100%. ISCH is a rare condition causing progressive thoracic myelopathy, and the natural history is unknown. There is a lack of evidence-based treatment strategies, and the majority of cases are treated with surgical management at diagnosis. Management of ISCH needs to be individualized for each patient, and clinicians should be encouraged to report new cases, standardize case reports, and ensure long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Prada et al . [17] reported a series of 12 ISCH cases, with 50% of patients showing improved symptomatology after surgery, and the others remained free from symptom progression. Another series of 12 patients, with a mean follow-up period of 74 months, described postoperative improvement in all cases.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic spinal cord herniation: Clinical review and report of three cases

et al. 2013

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“…7 Prada et al described a series of 12 patients in which all patients underwent surgical correction via a posterior approach, with reduction of the herniated spinal cord, positioning of a muscular autograft to fill the anterior cavity, and closure of the dural defect with an artificial dural patch. 5 In this case, a possible reason why the initial dural repair failed in the initial vertebrectomy when the durotomy occurred was that the dural substitute was placed over the durotomy, i.e., on the outside of the thecal sac. This placement allows for pulsation of CSF or cord to push the patch away from the defect, and increases the risk of CSF leak and/or cord herniation (rarely).…”

Section: Discussionmentioning

confidence: 97%

Spinal cord herniation as a complication of en bloc, multilevel, anterior thoracic vertebrectomy for a giant cell tumor: success of posterior cord reduction and dural repair

Kawsar

Bhatia²,

Casey³

2014

SPI

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Iatrogenic spinal cord herniation is a rare complication following spinal stabilization surgery. The authors present a case of circumferential thoracic tumor decompression and fixation by anterior instrumentation complicated by delayed anterior spinal cord herniation. This complication resulted in progressive paraparesis 5 years after the original procedure. The patient underwent reexploration and repair of the dural defect, resulting in the reduction of the spinal cord to its normal position. The patient's paraparesis improved significantly after dural repair. Although progression of neurological deficit can be very slow, repair of the dural defect can restore normal spinal cord alignment and improve neurological deficit. To the best of the authors' knowledge, this is the first reported case of spinal cord herniation following an anterior thoracic vertebrectomy.

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“…[2][3][4] A well-defined set of MR imaging diagnostic criteria has been established for STSCH 2,[4][5][6] ; however, little has been said about postoperative MR imaging of changes in the spinal cord and adjacent structures. Less than half of the cases reported in the literature have described postoperative MR imaging features after reduction of spinal cord herniation 1,4,[7][8][9][10] ; none provided descriptions of a rational analysis; and in cases of complications, few have performed time-related assessments of the findings. The lack of a thorough knowledge of postoperative MR imaging findings and their evolution with time can lead to misinterpretations of normal postoperative changes and oversight of complications.…”

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confidence: 99%

Postoperative MR Imaging of Spontaneous Transdural Spinal Cord Herniation: Expected Findings and Complications

Gaudino

Colantonio

Schiarelli

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Spontaneous transdural spinal cord herniation is no longer a rare cause of myelopathy. The high frequency of diagnoses has led to an increase in the number of surgical procedures. The purpose of this study was to describe the spectrum of postoperative MR imaging findings concerning spontaneous transdural spinal cord herniation and to provide a practical imaging approach for differentiating expected changes and complications after an operation.

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Spinal cord herniation: Management and outcome in a series of 12 consecutives patients and review of the literature

Abstract: The authors present one of the largest studies to date regarding patients with spinal cord herniation and emphasize that the possibility of this condition must be kept in mind when addressing all patients with progressive myelopathy.

Cited by 34 publications

References 43 publications

Idiopathic spinal cord herniation: Clinical review and report of three cases

Idiopathic spinal cord herniation: Clinical review and report of three cases

Spinal cord herniation as a complication of en bloc, multilevel, anterior thoracic vertebrectomy for a giant cell tumor: success of posterior cord reduction and dural repair

Postoperative MR Imaging of Spontaneous Transdural Spinal Cord Herniation: Expected Findings and Complications

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