Transdural Spinal Cord Herniation: An Exceptional Complication of Thoracoscopic Discectomy: 2-Dimensional Operative Video

Abstract

Thoracic disc herniation is a rare and severe condition, whose treatment may have complications including dural tears. Although benign in most cases, dural tears may induce iatrogenic transdural herniation of the spinal cord. The video demonstrates the diagnosis and surgical treatment of iatrogenic transdural herniation of the spinal cord. Here, we report a case of spinal cord herniation after thorascopic treatment of a thoracic disc herniation (DH). A 28-yr-old male presented with several years of left lower extremity weakness and was found to have a T6-7 DH. He underwent DH resection through video assisted mini-thoracotomy at another institution. In the immediate postoperative period, he developed a Brown-Sequard syndrome with left leg weakness. The surgeon decided not to reoperate and the patient improved with rehabilitation, allowing him to walk again. At 6 mo postop, he experienced sudden neurologic worsening but did not present to our clinic until 6 mo later. At this time, he had near complete paraplegia with bilateral lower extremity spasticity and central neuropathic pain. MRI showed a pseudo-meningocele and features suggesting a lateral spinal cord herniation. After a multidisciplinary meeting, we elected to perform a posterolateral approach with costo-arthro-pediculectomy and durotomy to repair the SC herniation. Immediately postop, the patient had a slight improvement in right lower extremity function, with decreased pain and spasticity. This case shows a transdural SC herniation, a rare complication after resection of DH. It is possible that an unreported or unrecognized dural tear at the time of the initial surgery, combined with the negative pressure of the thoracic cavity, put the patient at risk for this particular complication. The authors state that the patient gave his informed consent.

Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review

“…We reviewed cases of BSS caused by thoracic vertebral pathologies and their treatments reported from 1978 to 2021 14 – 44 ( Table 1 ). Among these 50 cases, the age at presentation ranged from 11 to 76 years (average, 45.9 years).…”

Commentary: Transdural Spinal Cord Herniation: An Exceptional Complication of Thoracoscopic Discectomy: 2-Dimensional Operative Video

“…e reviewed with great interest the video submission detailing the treatment of a surgical complication following thoracoscopic resection of a thoracic herniated disc. 1 The authors describe a 28-yr-old male patient with left leg pain who underwent an anterior surgical approach via a mini thoracotomy with thoracoscopic assistance for resection of a herniated disc at T6/T7. Postoperatively, the patient developed Brown-Sequard syndrome that progressed to paraplegia over 6 mo.…”