Spontaneous transdural spinal cord herniation

Castelnovo, Giovanni; Hladky, J P; Renard, Dimitri

doi:10.1212/wnl.0000000000000286

Cited by 8 publications

(3 citation statements)

References 1 publication

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“…Apparently, most reported cases were associated to traumas [5], following them sometimes decades later [6]. There are "spontaneous" or "idiopathic" [2,[7][8][9][10]; and rarely, iatrogenic cases reported. Extremely rare are those cases where the spinal cord herniates into pseudomeningokeles caused by traumatic nerve root avulsion [11,12].…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Spinal Cord Herniation: Why Anterior Thoracic?

Szücs¹,

Horváth²,

Várallyay³

2015

J Neurol Neurosci

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“…2-5 MRI usually shows a ventral displacement of the spinal cord with absent of cerebrospinal fluid (CSF) flow or CSF signal in the ventral region. 6,7…”

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confidence: 99%

Idiopathic Ventral Spinal Cord Hernia—A Single-Center Case Series of 11 Patients

Jesse

Gallus

Beck

et al. 2022

Operative Neurosurgery

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BACKGROUND:Idiopathic spinal cord herniations (ISCH) are rare defects of the ventromedial or mediolateral dura mater with herniation of the spinal cord through the defect with approximately 350 described cases worldwide. Patients usually become symptomatic with motor or sensory neurological deficits and gait disturbances.OBJECTIVE:To describe characteristic symptoms and clinical findings and to evaluate the postoperative course and outcomes of ISCH.METHODS:We present a single-center data analysis of a case series of 11 consecutive patients who were diagnosed with ISCH and underwent surgery in our department between 2009 and 2021.RESULTS:All herniations were located in the thoracic spine between T2 and T9. In most cases, gait ataxia and dysesthesia led to further workup and subsequently to the diagnosis of ISCH. A “far-enough” posterior-lateral surgical approach, hemilaminectomy or laminectomy with a transdural approach, was performed under intraoperative neurophysiological monitoring which was followed by adhesiolysis, repositioning of the spinal cord and sealing using a dura patch. After surgery, clinical symptoms improved in 9 of 11 patients (81.8%), while only 1 patient experienced deterioration of symptoms (9.1%) and 1 patient remained equal (9.1%). The median preoperative McCormick grade was 3 (±0.70), while the median postoperative grade was 2 (±0.98) (P = .0047).CONCLUSION:In our case series of ISCH, we found that in most patients, neurological deficits improved postoperatively. This indicates that surgery in ISCH should not be delayed in symptomatic patients.

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“…However, multiple cases have been described in the literature 1 2. Some have followed trauma but most are apparently spontaneous, although in retrospect there may be associated osteophytes or disc protrusions 2.…”

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confidence: 99%

Transdural spinal cord herniation with extradural cerebrospinal fluid collection

Carroll

Teo

2015

Pract Neurol

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A 58-year-old female nurse with a background of asthma gave a 7-year history of slowly progressing 'stiff knees' and stumbles. A rheumatological diagnosis was suspected; however, bilateral lower-limb radiological investigations were normal. Her gait slowed to the extent that she had to take leave from work and required a walking stick. Subsequently, she developed gradual onset of altered sensation below the thorax with urinary incontinence and difficulty in passing stool. She therefore presented to the emergency department.On examination, she had reduced strength of right ankle dorsiflexion and plantarflexion and a sensory level with a loss of proprioception and touch sensation below T6. An MR scan of spine (figure 1A) showed a spinal cord herniation at T5/T6 adjacent to a vertebral osteophyte, indicating a site and mechanism of a dural tear. We noted anterior cerebrospinal fluid (CSF) signal that was extradural and anterior to the thecal sac (figure 1B) extending from the cervical cord to the lumbar spine ( figure 1A). A CT myelogram (figure 1C, D) confirmed an epidural collection of contrast, consistent with a CSF leak (figure 1C, yellow asterisk) and more clearly identified the vertebral osteophyte ( figure 1D, blue arrow).Neurosurgical management involved a T4, T5 laminectomy with identification of a rightward rotated spinal cord. The surgeon identified the dural defect and noted a herniated spinal cord with a yellowish, gliotic appearance. The dural opening was expanded and adhesions Figure 1 Imaging of transdural spinal cord herniation. MR scan of spine in sagittal (A) and transverse section (B) shows cord herniation at T5/T6 with anterior cerebrospinal fluid (CSF) signal extradurally. CT myelogram in identical planes (C and D) confirming an epidural CSF leak (C, yellow asterisk) and vertebral osteophyte (D, blue arrow).

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Spontaneous transdural spinal cord herniation

Cited by 8 publications

References 1 publication

Spinal Cord Herniation: Why Anterior Thoracic?

Spinal Cord Herniation: Why Anterior Thoracic?

Idiopathic Ventral Spinal Cord Hernia—A Single-Center Case Series of 11 Patients

Transdural spinal cord herniation with extradural cerebrospinal fluid collection

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