Spontaneous Spinal Cord Herniation: Case Report and Review of the Literature

Tekkök, İsmail H.

doi:10.1097/00006123-200002000-00044

Cited by 80 publications

(94 citation statements)

References 22 publications

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“…The first strategy is closure of the dura defect, either by DS of the ventral dural defect (12,15,16,34,80,82,87,91) or by filling the dural defect with a fat graft (73), or by using a patch (fascia, pericard, or some other artificial material) to cover or suture the dural defect (ADP) (5, 8, 9, 11, 15, 17, 22, 24-26, 30, 32, 36, 37, 42-48, 52, 53, 56, 57, 62, 65, 66, 71, 72, 78, 79, 81, 82, 84, 88, 89) after releasing the spinal cord and reducing the herniation. Promoters of this strategy state that closure of the dura defect is necessary to prevent postoperative CSF circulation disturbances that may be produced by an extradural CSF collection (43) and because of the risk of recurrent spinal cord herniation (31,78). Also, realignment of the spinal cord is thought to be essential, and it is claimed that this can only be achieved by covering or closure of the ventral dura defect (78).…”

Section: Neurosurgerymentioning

confidence: 99%

“…Promoters of this strategy state that closure of the dura defect is necessary to prevent postoperative CSF circulation disturbances that may be produced by an extradural CSF collection (43) and because of the risk of recurrent spinal cord herniation (31,78). Also, realignment of the spinal cord is thought to be essential, and it is claimed that this can only be achieved by covering or closure of the ventral dura defect (78).…”

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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Section: Neurosurgerymentioning

confidence: 99%

Section: Neurosurgerymentioning

confidence: 99%

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Groen

Middel

Meilof

et al. 2009

Operative Neurosurgery

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“…ISCH was first reported by Wortzman et al [16] in 1974. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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]. In addition, within several mechanisms suggested as cause of nervous system involvement in AS, inflammation and compression are the main causative mechanisms [23,24].…”

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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“…These pulsations might push the spinal cord through the emerging dural defect [9,11,13,18,[20][21][22][23][24][25]. (2) Other hypothetical causes of ventral dural erosion are unnoticed minor traumas, medial protrusions of the vertebral disk, congenital abnormal adhesions of the spinal cord to the anterior dura [20] or even coughing [26,27].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Spinal Cord Herniation: MR Imaging and Clinical Features in Six Cases

et al. 2008

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Background and Purpose: Spontaneous spinal cord herniation (SSCH) is a rare but important differential diagnosis of spinal cord disorder. The aim of this study was to evaluate the topography and lesion pattern in six patients with SSCH by magnetic resonance imaging (MRI) and their correlation with clinical symptoms. Material and Methods: MRI was evaluated according to intramedullary hyperintense signal changes, alterations of the posterior vertebra and dorsal subarachnoid space at the level of the herniation. Neurologic symptoms as well as their progression were analyzed. Results: SSCH occurred between the level of T3-T7 and were demonstrated best on sagittal and axial T2-weighted images (T2-WI). Hyperintense signals on T2-WI were seen in five patients. Dorsal margins of the vertebra at the level of herniation were scalloped in three patients and one patient showed a sagittal cleft. Mean time from the initial clinical symptoms to diagnosis was 4.2 years. Incomplete Brown-Séquard' syndrome was the most common clinical presentation in our patients (four cases). Conclusion: SSCH is best diagnosed using multiplanar T2-WI with characteristic imaging findings of herniation and adjacent structures. Coexistent notches or even sagittal clefts in the dorsal vertebra raise the hypothesis that SSCH might originate from malfusion of the notochord. ZusammenfassungHintergrund und Ziel: Die spontane Myelonherniation (SMH) ist eine seltene, aber wichtige Differentialdiagnose spinaler Pathologien. Ziel dieser Studie war es, Topographie und Verteilungsmuster der SMH zu ergründen und mit den klinischen Symptomen zu korrelieren. Material und Methodik: Die Bildgebung mittels MRT, CT und Myelographie bei sechs Patienten (vier Frauen, zwei Männer; Durchschnittsalter: 41 Jahre) erfasste intramedulläre Signalalterationen, Veränderungen der Wirbelkörperhinterkanten sowie des Subarchnoidalraumes. Die neurologischen Symptome und deren Verlauf wurden ausgewertet. Ergebnisse: Die SMH erfolgte in Höhe der BWK (Brustwirbelkörper) 3-7 und stellte sich am deutlichsten in den sagittalen und axialen T2-gewichteten Sequenzen dar. Intramedulläre Signalalterationen fanden sich bei fünf der insgesamt sechs Patienten. Assoziierte Einkerbungen der Wirbelkörperhinterkanten traten bei drei Patienten auf, einmal sogar mit sagittaler Spaltbildung. Die Anamnese von initialen Symptomen bis zur Diagnosestellung einer SMH betrug im Mittel 4,2 Jahre. Dabei war ein inkomplettes Brown-Séquard-Syndrom bei vier Patienten die häufigste klinische Präsentation. Schlussfolgerung: Bei klinisch über Jahre langsam progredientem Brown-Séquard-Syndromen in Höhe des oberen und mittleren Thorakalmarkes ist die SMH eine wichtige Differentialdiagnose. Die Ätiologie für dorsale Eindellungen oder sogar Spaltbildungen der korrespondierenden Wirbelkörper könnte in Fusionierungsstörungen des embryonalen Notochords begründet liegen.Schlüsselwörter: Spinale Myelonherniation · Brown-Séquard-Syndrom · Dorsale Arachnoidalzyste · Magnetresonanztomographie · Sagittaler Spalt

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Spontaneous Spinal Cord Herniation: Case Report and Review of the Literature

Cited by 80 publications

References 22 publications

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

Operative Treatment of Anterior Thoracic Spinal Cord Herniation

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

Spontaneous Spinal Cord Herniation: MR Imaging and Clinical Features in Six Cases

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