Spinal Cord Herniation Research Articles

特発性脊髄ヘルニアの１例

Spinal cord herniation is a rare cause of neurological symptoms. We report a case of a 72-year-old woman presented with myelopathy of the lower right extremity and sensory disturbance of the lower left extremety. Three years earlies the subject experienced weakness in the right leg and numbness in the left leg. The patient did not have a history of injury or spine surgery. The symptoms worsened until examination by the authors three years, later by MRI, myelography, and CT scan. MRI scan well revealed spinal cord anterior deviation at the Th5 level. In operation, dura membrane defect, duplicated dura, and spinal cord herniation were observed. Laminectomy and dural fixation with artificial dura were performed. After operation, the patient's complaints gradually decreased.

Spontaneous spinal cord herniation

Spontaneous spinal cord herniation is a rare and under recognized condition. The commonest presentation is a Brown-Sequard syndrome. It most commonly occurs in the thoracic region through an anterolateral dural defect, and the pathophysiology is ill understood. We present a case of spontaneous spinal cord herniation along with a review of literature.

Surgical management of idiopathic spinal cord herniation: a review of nine cases treated by the enlargement of the dural defect.

Spinal cord herniation is a rare cause of progressive myelopathy and can be corrected surgically. In most previous reports, closure of the dural defect was the recommended procedure. The object of this paper is to describe a new procedure in which spinal cord constriction is released by enlarging the hiatus; additionally the postoperative results will be discussed. In nine patients with spinal cord herniation, enlargement of the dural defect was performed. In eight patients, neurological deficits resolved immediately after surgery. In one patient with a severe preoperative neurological deficit whose spinal cord herniated massively, deterioration occurred postoperatively. To date, no recurrence of herniation has been observed. The goals of surgery are to reduce the herniation, return the spinal cord to the normal position, and prevent the recurrence of herniation. The use of sutures to close the dural defect has been the method of choice to date. The surgical space in front of the spinal cord, however, is insufficient to accommodate this procedure safely. Because symptoms are caused by the constriction of the spinal cord at the hiatus, surgical expansion of the hiatus allows the goals of surgery to be achieved. This procedure, which is technically easier and less invasive with regard to the vulnerable spinal cord than the closure of the dural defect, could be a viable alternative for the treatment of this rare disease.

The natural history of transdural herniation of the spinal cord: case report

We report a patient with a Brown-Séquard syndrome who developed ventral transdural spinal cord herniation, showing the imaging findings changing over time from two thoracic disc protrusions with a normal spinal cord to a cord trapped within a bony defect in a thoracic vertebra.

Idiopathic spinal cord herniation

Spinal cord herniation is a rare condition that has become increasingly recognised in the last few years. The authors report a case of idiopathic spinal cord herniation in a 33 year old woman who presented with progressive Brown-Sequard syndrome. The di agnosis was made on MR imaging. After repairing the herniation the patient made a gradual improvement. Potential causes are discussed, including the possible role of dural tethering. In conclusion, idiopathic spinal cord herniation is a potentially treat able condition that should be more readily diagnosed with increased awareness and newer imaging techniques such as high resolution MRI.

Treatment of idiopathic spinal cord herniation with surgery-two cases

Treatment of idiopathic spinal cord herniation with surgery-two cases

Spontaneous Herniation of the Thoracic Spinal Cord: A Case Report

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dura. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord herniation manifesting as ventrolateral protrusion of thoracic spinal cord through a dural defect.

Brown-Sequard症候群を呈した胸髄脊髄ヘルニアの1例

9年前に背部打撲の既往があり, Brown-Sequard症候群を呈した脊髄ヘルニアの症例を報告した。MRI上Th4/5レベルにおいて, 脊髄が腹側に偏位しており, その背側にクモ膜嚢胞と思われる領域を認めた.手術にて脊髄背側のクモ膜嚢胞と腹側硬膜欠損部への脊髄ヘルニアを確認し, これを整復, 硬膜形成術を行った.MRIの登場以後, 脊髄ヘルニアの報告例は増加してきており, 従来考えられてきたほど稀な疾患ではないと思われる.硬膜欠損の成因が病態の基本であるが, そのメカニズムについては推論の域をでていない.大きく, 特発性と外傷性に分類されるが, 文献的考察にてそれぞれの臨床的特徴を考察した.今回われわれが報告した症例は, 背部打撲の既往を有するものの, 特発性の範疇に入ると考えた.

Spinal cord herniation into an extradural arachnoid cyst

A herniation of the thoracic spinal cord into the mouth of an extradural arachnoid cyst is reported in a 37 year old man. This is the 20th case, but the first posterior herniation; all the others were anterior. He presented with progressive paraparesis and the magnetic resonance imaging (MRI) showed kinking of the cord into the cyst. Surgical release of the neck of the hernia was successful.

Idiopathic spinal cord herniation

The authors describe two occurrences of idiopathic spinal cord herniation, an entity that has been reported previously in only 11 cases. The patients described in this report presented in midlife with Brown-Séquard syndrome. Computerized tomography myelography and magnetic resonance (MR) imaging showed ventral displacement of the spinal cord with no apparent dorsal mass. Intraspinal cerebrospinal fluid (CSF) flow studies in which phase-contrast pulse sequence cine MR imaging was used displayed a normal pattern dorsal to the spinal cord. Percutaneous intrathecal endoscopic observation did not disclose dorsal intradural cysts, but ventral adhesions were seen between the spinal cord and the dura. Microsurgical intradural exploration revealed ventrolateral herniation of the cord and a ventral root through a dural defect into an epidural arachnoid cyst. The adhesions were released, the cord was repositioned intradurally, and the dural defect was patched. The patients showed gradual improvement postsurgery, as did most of the patients in the previously reported cases. The CSF flow and endoscopic studies were found to be particularly informative, and dural patching with surgical membrane is recommended.

Ultrafine flexible spinal endoscope (myeloscope) and discovery of an unreported subarachnoid lesion.

Introduction of a new diagnostic procedure and a report on its usefulness. To introduce a new endoscope (myeloscope) developed for the examination of the spinal canal and to present a previously unreported subarachnoid condition as a cause of paraparesis revealed by it. In spite of the availability of advanced imaging technology, there still exists a significant number of patients with spinal diseases in whom a diagnosis cannot be made. Direct visualization of the pathologic area is required in these patients. Recent advances in fiberoptics have made this possible. The endoscope consisted of a fiberscope with an external diameter of 0.5, 0.9, or 1.4 mm. It was inserted into the subarachnoid space in the lumbar spine and carefully advanced cranially. Since 1987, this examination has been performed on 18 patients aged 7 to 69 years who had pain or other neurologic symptoms of unknown origin. The surface of the spinal cord, roots, properties of the arachnoid membrane, and small vessels could be observed clearly. The scope could be advanced as far as the upper cervical spine. Cotton-candy-like proliferation of fibrous tissue was identified by myeloscopy in four paraparetic patients who had clinical and radiologic features similar to those of a spinal cord herniation. The fibrous tissue beat on the spinal cord with the pulsation of the spinal fluid. Resection of the fibrous tissue with conventional surgery resulted in neurologic improvement. Complications included one case of meningitis in the early period and five cases of postspinal headache. No nerve injury was apparent. Myeloscopy provides detailed information about the subarachnoid space and even reveals dynamic conditions that cannot be identified during open surgery or at autopsy. It will bring new concepts to the diagnosis of spinal diseases.

脊髄くも膜嚢胞の臨床的検討

The clinical findings in five intradural and two extradural arachnoid cysts were discussed. All patients of intradural arachnoid cyst were female, and their lesions were located at the upper or mid thoracic level. Three patients showed sensory disturbance and five showed motor weakness of the lower extremities. MRI and CTM showed enlargement of the subarachnoid space and displacement of the spinal cord. One patient had syringomyelia, two had cervical disc disease, and two had spinal cord herniation at the thoracic level. During the operation, the cyst walls were removed in all patients. Simaltaneously, herniated spinal cords were replaced intradurally. Later, cervical anterior fusion was performed in one patient, but another patient was follow-up without recourse to an operation. Syringomyelia disappeared without any direct treatment. The patients showed good recovery after operation, but the patients of extradural arachnoid cyst showed weakness and sensory disturbance of the lower extremities. Their dural defects were located at the thoracic level. MRI and CTM showed large cysts and bone erosion. After removal of the cyst wall and closure of the dural defect, each patient made a good recovery. Although MRI and CTM were helpful both for diagnosis and operation, 3D MR myelography would have been helpful to show the three dimentional relationship of the cyst and the subarachnoid space, as well as the pathogenesis of the arachnoid cyst and/or spinal cord herniation.

Tethered thoracic cord resulting from spinal cord herniation

Tethered cord syndrome (TCS) usually involves tethering of the lower cord at the conus medullaris from dural abnormalities, but may occur after spinal cord herniation. A tethered thoracic spinal cord is rare. We present an unusual case of a 30-year-old woman with a history of myelopathy presumed to be secondary to T6 cord compression resulting from T6–T8 arachnoid cyst. She continued to deteriorate after partial excision of the cyst. Repeat magnetic resonance imaging suggested recurrence of the presumed arachnoid cyst with cord compression and showed tethering at T6–T8. Surgical exploration revealed myelocele with cord herniation through the anterior thoracic dura. Pathologic diagnosis showed neural tissue with gliosis. After physical therapy treatments, the patient had increased lower extremity strength, ambulated with a cane, and regained some bladder control. Progressive myelopathy may represent tethering of the cord resulting from cord herniation. Early recognition of TCS, even in patients with minimal neurologic deficits, could prevent progressive disability.

Spinal cord herniation after stabbing injury

A 19-year-old man presented with delayed paraplegia on the second day after a stab injury of the spine. Magnetic resonance imaging showed herniation of the spinal cord through the dural defect. After emergency surgery, his paraplegia recovered leaving a Brown-Sequard syndrome immediate after injury. Spinal cord herniation should be considered as one of the possible factors in patients developing neurological deterioration after a stab injury of the spine. The possible pathogenesis of symptomatic non-spontaneous spinal cord herniation is discussed.

Idiopathic dural herniation of the thoracic spinal cord

Idiopathic dural herniation of the thoracic spinal cord

Herniation of the spinal cord 38 years after childhood trauma

Herniation of the spinal cord 38 years after childhood trauma

Idiopathic Spinal Cord Herniation

The authors experienced unique cases of spinal cord herniation. Only eight cases of spinal cord herniation have been reported formerly. The authors report two cases of spinal cord herniation accompanied with double structure of dura mater (duplicated dura mater). The causes of their condition are discussed in this report.

Spinal Cord Herniation Associated with an Intradural Spinal Arachnoid Cyst Diagnosed by Magnetic Resonance Imaging

Abstract Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst. (Neurosurgery 29:137-139, 1991)

Spinal cord herniation associated with an intradural spinal arachnoid cyst diagnosed by magnetic resonance imaging

Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst.

くも膜嚢腫と二重硬膜とを伴った特発性脊髄ヘルニアの一例

Idiopathic spinal cord herniation is very rare, 5 cases being so far reported in the literature. A 71-year-old-woman with a gradual loss of power in her left leg and with a sensory disturbance in the lateral side of her right leg was admmited. MRI showed that from Th4 to Th5, the spinal cord was shifted ventrally and disappeared, and a dilated subarachnoid space was noticed dorsally. She was diagnosed spinal cord herniation associated with an arachnoid cyst, and the operation was done. During operation, not only an intradural arachnoid cyst was obsreved dorsally, but was duplicated dura mater ventrally. In the ventral lesion, the spinal cord was herniated through a defect of the inner layer of the dura mater. This dural inner layer as well as the arachnoid cyst was resected. Her clinical symptoms were not progressed.When the spinal cord is shifted or disappeared in an image, we should precisely determine the relationship between the spinal cord and the dura mater during operation with consideration of a possibility of the presence of idiopathic spinal cord herniation.