Traumatic Ventral Cervical Spinal Cord Herniation: A Case Report

Khattar, Nicolas K; Donovan, Andrew M; Oxford, Brent G.; Adams, Shawn; Altstadt, Thomas

doi:10.7759/cureus.4070

Cited by 3 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In traumatic spinal cord herniation, the level of herniation is not typically mid-thoracic ventral occurring mainly in middle age, but spinal cord herniation occurs at the level of trauma, which may be cervical or low-thoracic. Herniation may also occur at the dorsal level instead of at the ventral level, may be associated with nerve root avulsion, and occur at any age ( 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: A vertebral bone spur as an etiology for spinal cord herniation: case presentation, surgical technique, and review of the literature

et al. 2023

View full text Add to dashboard Cite

ObjectiveThe pathophysiology of idiopathic spinal cord herniation remains unknown. However, several different factors have been postulated, such as congenital causes (ventral dura mater duplication, preexisting pseudomeningocele, or other congenital dural defects), inflammation, remote spinal trauma, or thoracic disc herniation. Herein, the diagnosis and surgical treatment of a patient with spinal cord herniation caused by an intraspinal bone spur is presented along with a relevant literature review.Case presentationA 56-year-old male patient presented with a non-traumatic Brown-Sequard syndrome persisting for over 1 year. A magnetic resonance imaging of the spinal axis revealed a ventral spinal cord displacement in the level of T 6/7. A supplementary thin-sliced computed tomography of the spine revealed a bone spur at the same level. For neurosurgical intervention, T 6 and T 7 laminectomy was performed. The cranial and caudal end of the right paramedian ventral dural defect was visualized and enlarged. Following extradural spinal cord mobilization by denticulate ligament transection, the spinal cord was finally released. The spinal cord was rotated and the ventral closure of the dural defect was performed by continuous suture. The patient recovered from surgery without additional deficits. The patient’s postoperative gait, sensory, and motor function deficits improved, and further neurological deterioration was prevented.ConclusionSince the first description of spinal cord herniation by Wortzman et al. in 1974, approximately 260 cases have been reported in the literature. In addition to other causes, intraspinal bone spur is a possible cause of spinal cord herniation.

show abstract

Section: Discussionmentioning

confidence: 99%

Case report: A vertebral bone spur as an etiology for spinal cord herniation: case presentation, surgical technique, and review of the literature

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Spinal cord herniation is described in the literature as a rare cause of spinal cord dysfunction, 1,[5][6][7][8] which is often amenable to surgery. It can commonly be classified into spontaneous, iatrogenic, and posttraumatic.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous and idiopathic presentations have been described more commonly in the literature, and herniation due to a traumatically acquired dural defect is the least reported cause. 1 Iatrogenic dorsal cord herniation has been described even more rarely, 9 with only 13 cases reported in the literature to date ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Spinal cord herniation in and of itself has been noted to be a rare phenomenon and should be suspected in individuals who present with an unusual combination of motor/sensory and autonomic deficits. 1 Dorsal herniation of the cord due to iatrogenic causes is an even more uncommon phenomenon, with only 13 reported cases in the literature to date ( Table 1 ), and these cases have been most commonly due to spinal surgery.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case

Ogbu

Eltoukhy

Tzerakis

2021

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND The case report detailed an unusual presentation of an iatrogenic dorsal cord herniation at the level of the thoracic cord after insertion of an epidural catheter 8 months before presentation to the neurosurgical clinic. OBSERVATIONS Only 13 cases of iatrogenic dorsal cord herniation, most of which occurred after spinal surgery, have been described in the literature. This was the first case of a spinal cord hernia described after the insertion of an epidural catheter. In this case study, the authors described a 38-year-old man who presented with progressive lower limb weakness, sensory deficits, perianal numbness, and urinary/fecal incontinence. He was diagnosed with a spinal cord hernia that reherniated after an initial sandwich duroplasty repair. Definitive repair was made after his re-presentation using an expansile duroplasty. LESSONS In patients with previous spinal instrumentation who present with neurological symptoms, spinal cord herniation should be considered a likely differential despite its rarity. In this case, a simple duroplasty was insufficient to provide full resolution of symptoms and was associated with recurrence. Perhaps a combination of graft and expansile duroplasty may be used for repair, especially when associated with a tethered cord and in the presence of significant adhesions.

show abstract

“…Till now, existing documents of idiopathic spinal cord herniation are only limited to case reports, and the preoperative diagnosis is exceedingly challenging ( 2 – 8 ). The pathogenesis of dural defect formation and spinal cord herniation remains unknown; over the past decades, several causes have been hypothesized based on the intraoperative observations, such as trauma ( 9 ), congenital deficiency in the dura ( 10 ), and pressure-related erosion secondary to the intervertebral disc herniation ( 11 ). Due to the paucity of enough clinical evidence, the treatment and prognosis of idiopathic spinal cord herniation are still elusive ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Idiopathic Spinal Cord Herniation: An Overlooked and Frequently Misdiagnosed Entity

et al. 2022

View full text Add to dashboard Cite

BackgroundIdiopathic spinal cord herniation is an extremely rare entity that is characterized by protrusion of the spinal cord through a defect in the ventral dura. Due to the paucity of enough clinical evidence, the treatment and prognosis of idiopathic spinal cord herniation are still elusive. Herein, we reported a case of idiopathic spinal cord herniation occurring at the C7–T1 levels that was treated by surgical reduction.Case descriptionA 44-year-old Chinese woman presented with a 5-year history of numbness and weakness in the bilateral lower limbs. Spinal magnetic resonance imaging demonstrated ventral displacement of the spinal cord at the C7–T1 levels, and there seemed to be a cuneiform space-occupying lesion dorsal to the spinal cord. A diagnosis of the spinal intradural extramedullary tumor was suspected. An exploratory operation was performed via a posterior midline approach. Intraoperatively, we found a defect in the ventral dura through which the spinal cord herniated to the epidural space. After the herniated parenchyma was returned, an artificial dura matter was used to repair the defect. The postoperative course was uneventful. After a 3-month follow-up, the lower-extremity weakness was significantly improved, and there was no recurrence of the spinal cord herniation.ConclusionPreoperative diagnosis of idiopathic spinal cord herniation is exceedingly challenging. Surgical reduction of the herniated spinal cord with the repair of the dural defect is an effective approach for the treatment of this rare disorder, and the surgical outcome is favorable.

show abstract

Traumatic Ventral Cervical Spinal Cord Herniation: A Case Report

Cited by 3 publications

References 9 publications

Case report: A vertebral bone spur as an etiology for spinal cord herniation: case presentation, surgical technique, and review of the literature

Case report: A vertebral bone spur as an etiology for spinal cord herniation: case presentation, surgical technique, and review of the literature

Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case

Case Report: Idiopathic Spinal Cord Herniation: An Overlooked and Frequently Misdiagnosed Entity

Contact Info

Product

Resources

About