Spinal Cord Herniation Research Articles

Neurological and Psychiatric Adverse Events Associated with Cyclin-Dependent Kinase 4/6 Inhibitors in Breast Cancer Patients: Insights from a Pharmacovigilance Study via the FDA Adverse Event Reporting System.

Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have revolutionised cancer therapy, particularly breast cancer therapy. However, concerns about their potential to cause neurological and psychiatric adverse events (AEs) have emerged, and these concerns remain underexplored. This study aimed to investigate the signals related to neurological and psychiatric AEs associated with CDK4/6 inhibitor use. A retrospective study was performed to analyse reports of AEs associated with the use of CDK4/6 inhibitors (abemaciclib, ribociclib and palbociclib) from the first quarter of 2015 to the fourth quarter of 2023 on the basis of the FDA Adverse Event Reporting System (FAERS). Both the reporting odds ratio (ROR) and the multi-item gamma Poisson shrinker (MGPS) were used for signal detection. The timing of events was assessed with the Weibull shape parameter (WSP). The management, analysis and presentation of the data were performed via Python (version 3.8) and R software (version 4.3.2). A total of 19,001 AE reports in which CDK4/6 inhibitors were identified as the 'primary suspect drug' were included in this study. These events were predominantly observed in patients aged 65 to 85 years. Through an ROR analysis, 85 positive signals for neurological and psychiatric AEs associated with CDK4/6 inhibitors were identified. The MGPS method revealed 61 positive AE signals for neurological and psychiatric AEs associated with CDK4/6 inhibitors. A total of 34 positive AE signals were identified by both the ROR and MGPS analyses. The WSP indicated that the onset times for AEs associated with all three CDK4/6 inhibitors tended to be early in drug therapy, suggesting a propensity for early failuretype. The present study revealed neurological and psychiatric AEs associated with CDK4/6 inhibitors that often occur early in treatment. Significant signals include spinal cord herniation and cerebral microangiopathy. Close monitoring of these AEs is crucial. Further studies are necessary to verify the connection between CDK4/6 inhibitors and neurological and psychiatric AEs.

The clinical evolution of patients with idiopathic spinal cord herniation: a case series

Study designRetrospective case series of 48 patients.ObjectivesThis study’s primary objective was to provide a clinical description of a group of individuals with a working diagnosis of idiopathic spinal cord herniation (ISCH). The secondary objectives were to appreciate the natural history of these patients and describe their clinical evolution with conservative or surgical management.SettingThe study was carried out at l’Hôpital de l’Enfant-Jésus, CHU de Québec (Québec, Canada), a tertiary care university hospital.MethodsThis case series study is based on routinely collected data. Forty-eight (48) cases were identified as having an ISCH on MR imaging, between 2009 and 2019. Their medical files have been searched retrospectively. Patient characteristics were described according to their asymptomatic or symptomatic status.ResultsThe mean age of patients at the time of diagnosis was 52.5 years. Most of the patients identified were asymptomatic (69%) and followed clinically. The main neurologic presentation for the symptomatic group was Brown-Séquard-like syndrome. 20% of the symptomatic patients were rapidly treated surgically after consultation with the neurosurgeon. The mean follow-up duration was 56 months for asymptomatic patients and 51 months for symptomatic patients. Most of our patients (41 out of 45) were considered stable or unchanged at follow-up. There was no neurological progression in all asymptomatic patients.ConclusionsOur study shows that ISCH and its variants are not always symptomatic and may be a fortuitous finding. As the natural history may be non-progressive, it is probably appropriate to treat some cases expectantly.

De Novo Formation of Idiopathic Spinal Cord Herniation.

We investigated whether idiopathic spinal cord herniation is a congenital or acquired condition and undertook a study to determine the risk of developing iSCH in patients with persistent ventral spinal CSF leaks. De novo formation of iSCH was established among all 6 patients with iSCH who had undergone prior spinal imaging for symptoms unrelated to iSCH. Among 51 patients with persistent ventral spinal CSF leaks, iSCH developed in 2 patients (probability increased from 0% at 5 years to 9.4% at 10 years). This study shows that iSCH is an acquired condition, and early treatment of ventral CSF leaks offers a unique opportunity to prevent neurologic disability.

A Rare Case of Idiopathic Ventral Cord Herniation with Spastic Paraparesis Treated with Microsurgery and Intraoperative Neurophysiological Monitoring

Abstract Idiopathic ventral spinal cord herniation is an exceedingly rare and progressive cause of myelopathic presentation and is usually seen in the thoracic spinal cord. Our report here presents a typical clinical picture, the diagnosis, and surgical management of ventral cord herniation. The imaging shows ventral herniation of the dura through a formed defect in the ventral thecal sac. This herniation causes slow and progressive damage to the herniated cord and leads to the typical myelopathic picture with or without bowel and bladder involvement. Ventral cord herniation is a rare but treatable condition. It’s natural progression and methods of management need further research due to its rarity. Surgical treatment is needed in symptomatic cases and carries high risks, but the outcome is usually favourable. IONM is also useful during surgery to reduce deficits.

715 Outcome of Surgically and Conservatively Managed Spinal Cord Herniation

715 Outcome of Surgically and Conservatively Managed Spinal Cord Herniation

Unveiling the Current Understanding of Idiopathic Spinal Cord Herniation: A Systematic Review.

Idiopathic spinal cord herniation (ISCH) is a rare condition that is characterized by ventral herniation of the spinal cord through a defect in the dura mater into the epidural space, with no identifiable cause. ISCH is frequently underdiagnosed, and the information available in case reports is limited. To provide an overview of the clinical manifestations and diagnosis of this condition, this study aims to conduct a review of reported cases of ISCH. A literature review was carried out using seven databases. The search was conducted using the keywords "Idiopathic spinal cord herniation" OR "Idiopathic Ventral Spinal Cord Herniation" AND "Case report" OR "case series." A total of 92 relevant papers reporting 224 cases, besides the index case, were determined. Of the cases, 58.5% were females and the mean age was 50.7 (SD 13.2) years. Symptoms, diagnoses, and outcomes were similar between genders. The most common clinical signs included motor symptoms (82.6%), instability (61.3%), hypoesthesia (59.2%), and disturbance of thermal sensitivity (47.3%). Brown-Séquard syndrome was observed in 27.2% of the cases, and surgical treatment was employed in 89.7% of the cases. ISCH is a pathology that is principally treated with surgical approach. This study provides valuable insights into the clinical manifestations and diagnosis of ISCH, which can aid in the early recognition and treatment of this rare condition.

Postoperative Rare Presentation of Ventral Cervical Cord Herniation: A Case Report

Cervical spinal cord herniation is a rare occurrence and is usually seen after C3-C5 fusion with C4 corpectomy using a posterior approach. Herniation in the cervical spine with an anterior approach is unusual and has only been reported in a few cases. Hereby, a case of a 53-year-old male who underwent C3-C5 fusion with C4 corpectomy for Ossification of the Posterior Longitudinal Ligament (OPLL) of the cervical spine is reported. Following surgery, the patient deteriorated, leading to re-exploration. Delayed postoperative Magnetic Resonance Imaging (MRI) shows ventral cord herniation with an anterior pseudo meningocele. Spinal cord herniation should be considered if neurological deficits occur after C3-C5 fusion with C4 corpectomy

Idiopathic Thoracic Spinal Cord Herniation: Two Case Reports of a Frequently Misdiagnosed Pathology

Idiopathic Thoracic Spinal Cord Herniation: Two Case Reports of a Frequently Misdiagnosed Pathology

Long term follow up of surgery for thoracic spinal cord herniation :early and late outcome

Long term follow up of surgery for thoracic spinal cord herniation :early and late outcome

Iatrogenic spinal cord herniation

Introduction: Spinal cord herniation occurs idiopathically or is due to defective or weakened dura mater resulting from iatrogenic or traumatic lesions. Although there have been many reports of idiopathic cases, there are few reports of postoperative iatrogenic spinal cord herniation. The authors describe a rare case of postoperative spinal cord herniation in the cervical spine, with an extensive analysis of reported cases Materials and methods: This article reports a documented case of postoperative spinal cord herniation. The case description is followed by an analysis of the literature. Results: A 67-year-old woman who had cervical laminectomy 3 weeks before for cervical laminectomy, presented with neck pain and torticollis after coughing. The MRI findings showed a cervical medulla herniation with cerebrospinal fluid (CSF) leakage. The patient underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. Over the previous 50 years (1973–2023), 16 post-operative spinal cord herniation cases were reported. The mean patient age was 43.3 years (range 15–67 years). There was a male predominance (80%). The mean onset period after surgery was 292 weeks (range, 1 week to 728 weeks). Clinical symptomatology was polymorphic with non-specific signs. Conclusion: Iatrogenic spinal cord herniation is an extremely rare occurrence after spine surgery. The diagnosis must be evoked in case of any neurological degradation after surgery of the cervical spine, thoracic spine or thoracolumbar junction. The surgical management gives satisfactory clinical results.

Idiopathic Ventral Spinal Cord Herniation: An Illustrative Case and Literature Review

Background and Importance: Idiopathic spinal cord herniation (ISCH), or spontaneous spinal cord herniation, is a rare but serious condition that can cause progressive myelopathy and irreversible neurological deficits if left untreated. The condition is marked by the gradual herniation of the spinal cord through a ventral defect in the dura, leading to compromised blood flow and neurological deficits. Common symptoms include Brown-Séquard syndrome or asymmetrical paraparesis. Treatment options typically focus on reducing the strangulated spinal cord and closing the dural defect with a synthetic patch. Case Presentation: We present the case of an adult woman with progressive asymmetrical weakness of the lower limbs compatible with spastic paraparesis. Thoracic magnetic resonance imaging (MRI) revealed characteristic features of ISCH at the T3-T4 level. Intraoperative neurophysiological monitoring was used during the surgical intervention, which involved a 3-level laminectomy, dura opening, excision of the dentate ligament, and reduction of the cord across the dural defect. The defect was then filled with an autogenous piece of muscle, followed by the closure of the defect with an artificial dural patch and dural closure. At the 6-month follow-up, the patient showed favorable improvement. Conclusion: Patients with slowly progressive paraparesis or Brown-Séquard syndrome should consider the possibility of ISCH as a potential cause, despite its rarity. In symptomatic cases, the preferred treatment option often involves reducing the incarcerated spinal cord followed by covering the dural defect.

Unusual Presentation of a Transdural Spinal Cord Herniation

Idiopathic transdural spinal cord herniation (ITSCH) most commonly occurs through a ventral dural defect at the midthoracic levels with a predilection to affect middle-aged females. It can have various presentations, the most common of which are Brown-Sequard syndrome and spastic paraparesis. Due to its rarity in clinical practice, the diagnosis of ITSCH can be challenging to physicians unfamiliar with this entity. We report an unusual presentation of an ITSCH in a 23-year-old female. The diagnosis was made based on the findings of the spinal cord magnetic resonance.

Idiopathic spinal cord herniation—An extremely rare cause of paraparesis: Case report

Abstract Idiopathic spinal cord herniation is a rare disorder, consisting of a ventral displacement of the spinal cord through a dural defect. The resulting adhesion and vascular compromise lead to neurological impairment. We report the case of a 54-year-old male, with a previous urological surgery resulting in chronic vesical catheterization, with a worsening paraparesis associated with anesthesia below T10. The magnetic resonance imaging showed a ventral displacement of the spinal cord at T7/T8 with an enlarged posterior subarachnoid space at that level. A four-level laminotomy was performed followed by spinal cord herniation reduction and closure of the anterior dural defect with a dural replacement. The patient had a partial recovery of his motor deficits regaining his ability to walk with the support of a single crutch. The purpose of this study was to highlight the existence of this extremely rare cause of paraparesis, which is often misdiagnosed.

Treatment of patients with caudal regression syndrome: a systematic review of the literature

Objective. To analyze and summarize the data of modern literature on the issues of surgical treatment and natural course of the spine and spinal cord pathology in patients with various types of caudal regression syndrome (CRS).Material and Methods. A systematic review of the literature on the issue of treatment of the spine and spinal cord pathology in patients with CRS was performed. Selection criteria were: articles for the period 2002–2022, original studies of populations/patients with various forms of CRS with a description of treatment methods and long-term results of treatment or observation. A total of 28 articles on the treatment of various forms of CRS with the described results of treatment of 212 patients were analyzed: 29 patients with CRS in combination with open neural tube defects and 183 patients with closed forms of CRS. Evaluation criteria included number of patients, gender, type of spinal cord pathology, type of sacral agenesis, presence of the spine and lower extremities deformities, concomitant pathology, operations performed and their complications, and results.Results. The studied patients underwent the following surgeries on the spine and spinal cord: untethering of the spinal cord, correction and stabilization surgeries on the spine, plasty of the spinal cord herniation, plasty of the terminal meningocele, and removal of the presacarial volumetric mass. The greatest number of complications occurred after operations on the spine and sacrum. The majority of patients (67 %) with sacral agenesis by the end of the follow-up period (average 14 years) walked independently or with the help of devices, and a minority of them (33 %) could not walk. More than half of patients with CRS (67 %) had a neurogenic bladder, urinary incontinence, or suffered from a chronic urinary tract infection. Fecal incontinence and constipation were less common (46 %).Conclusions. Patients with CRS have a good potential for improvement/recovery of walking and pelvic organ dysfunction. This is extremely important to timely carry out multimodality treatment of patients with CRS who have neurosurgical, orthopedic, urogenital and colorectal problems in CRS, and to start early motor rehabilitation and physiotherapy.

Natural history and surgical outcomes of idiopathic spinal cord herniation.

Retrospective multicenter study. Although surgery is frequently selected for the treatment of idiopathic spinal cord herniation (ISCH), its impact on functional outcomes has yet to be fully understood given the limited number of patients in previous studies. This study aims to evaluate the symptomatic history and surgical outcomes of ISCH. Three institutions in Japan. A total of 34 subjects with ISCH were retrospectively enrolled and followed up for at least 2 years. Demographic information, imaging findings, and clinical outcomes were collected. Functional status was assessed using the JOA score. The types of neurologic deficit were monoparesis, Brown-Sequard, and paraparesis in 5, 17, and 12 cases, with their mean disease duration being 1.2, 4.2, and 5.8 years, respectively. Significant differences in disease duration were observed between the monoparesis and Brown-Sequard groups (p < 0.01) and between the monoparesis and paraparesis groups (p = 0.04). Surgery promoted significantly better recovery rates from baseline. Correlations were observed between age at surgery and recovery rate (p < 0.01) and between disease duration and recovery rate (p = 0.04). The mean recovery rates were 82.6%, 51.6%, and 29.1% in the monoparesis, Brown-Sequard, and paraparesis groups, respectively. The monoparesis group had a significantly higher recovery rate than did the Brown-Sequard (p = 0.045) and paraparesis groups (p < 0.01). Longer disease duration was correlated with the progression of neurologic deficit. Older age, and worse preoperative neurologic status hindered postoperative functional recovery. These results highlight the need to consider surgical timing before neurologic symptoms deteriorate.

Cervical Spinal Cord Herniation After Laminectomy

Following a recent cervical laminectomy, a 67-year-old female patient developed neck pain and torticollis after a coughing episode. On physical examination, manifestations of neck pain, stiffness, and 4/5 quadriparesis were noted. Magnetic resonance imaging findings indicated the presence of herniation of the cervical medulla, accompanied by cerebrospinal fluid leakage. Consequently, surgical intervention was performed to reposition the herniated cord within its original subarachnoid space, thereby averting potential recurrence. The patient experienced complete resolution of symptoms within a few days postoperatively. It is important to recognize that postoperative cervical spinal cord herniation following laminectomy is an infrequent complication that manifests with a delayed onset. Surgical repair serves as the main therapeutic modality.

Thoracic Anterior Spinal Cord Herniation: Treatment and Prognosis Outcome of Seven Patients

This study aimed to investigate the diagnosis and treatment of thoracic anterior spinal cord herniation, a rare condition. Clinical data of 7 patients diagnosed with thoracic anterior spinal cord herniation were analyzed. All patients were diagnosed with a complete preoperative examination and scheduled for surgical treatment. In addition, regular follow-up was performed after the surgery, and the operation's efficacy was evaluated according to clinical symptoms, imaging findings, and improvement in neurologic function. All patients underwent spinal cord release with an anterior dural patch. Notably, no severe postoperative surgical complications were observed. All patients were followed up for 12-75months, with an average duration of approximately 46.5months. Post-operative pain symptoms were controlled, neurological dysfunction and related symptoms improved to varying degrees, and anterior spinal cord herniation did not recur. The modified Japanese Orthopedic Association score at the last follow-up was significantly higher than the preoperative score. Clinicians should avoid misdiagnosing patients with thoracic anterior spinal cord herniation with intervertebral disc herniation, arachnoid cysts, and other related diseases, and patients should undergo surgical treatment as early as possible. In addition, surgical treatment can protect the neurologic function of patients and effectively prevent the aggravation of clinical symptoms.

P.146 Anterior spinal cord herniation following an anterior cervical discectomy and fusion: case report

Background: Anterior cervical discectomy and fusion (ACDF) and corpectomy is one of the most common spinal operations performed worldwide to treat herniated discs causing anterior spinal cord compression , cervical spondylosis, fractures, and neoplasms, with the routine complications. There have been just a few known cases of anterior spinal cord herniation following multilevel anterior ACDF and corpectomy fusion cases. Methods: A 53-year-old male initially presented with a 3 year’s duration of increasing myelopathy with history of Anterior cervical surgery C3 -5. About 10 years prior he was not able to walk had difficulty to use his hand. (he have nice images on MRI scan of typical spinal herniation)Results: Patient was initially treated medically with utilizing analgesia and physiotherapy and gradually deteriorated over two year. Patient revision surgery and release of spinal cord with intra-operative durotomy and release of the spinal cord. He had only mild improvement in hand function, No change in legs function post operatively. Conclusions: The occurrence of spinal cord herniation through a prior ACDF or Corpectomy defect must be considered when patients present with recurrent myelopathy following anterior cervical surgery. Early investigation and early release surgery can improve the outcome for these group of patients

Surgical management of idiopathic thoracal ventral spinal cord herniation: a case report

IntroductionIdiopathic spinal cord herniation is a rare entity that is characterized by the displacement of the spinal cord through a defect in the dural layer and presents with symptoms of myelopathy. Surgical management usually results in good outcomes.Case presentationA 58-year-old female patient presented with weakness of both legs since four months. Her neurological examination showed paraplegia in the lower extremities, and ventral herniation was detected in the T9 vertebral level. The patient underwent surgery. Left T9 hemilaminectomy was followed by the reduction in the herniated spinal cord into its physiological location and the covering the anteriorly located dural defect via circumferentially covering the dural surface of the corresponding vertebral level. Postoperatively, the patient’s neurological status improved gradually and radiological scans showed a total reduction in the herniation.ConclusionDespite the rarity of the pathology, spinal cord herniation should be included in the differential diagnosis of the patients presenting with myelopathy or Brown–Séquard syndrome.

A Rare Case of Idiopathic Spinal Cord Herniation Treated by DuraGen® Collagen Matrix Graft.

We report a rare case of idiopathic spinal cord herniation (ISCH) with a history of cerebrospinal fluid (CSF) leakage. ISCH is a protrusion of the spinal cord through a dural defect. Thin constructive interference in steady-state (CISS) images clearly demonstrated the herniated cord in the present case. The myelopathy worsened and the patient underwent surgery for reduction of herniated spinal cord; the dural defect was filled by placing collagen matrix graft (DuraGen®) between the inner and outer dural layers. The patient's symptoms have improved without relapse for 8 months since surgery. This method may be a good surgical option for cases of spinal cord herniation.