Thoracic Spinal Cord Herniation Research Articles

Thoracic transdural spinal cord herniation at a level caudal to prior discectomy

To outline a scenario of acquired transdural spinal cord herniation not previously described. The authors report their experience with a patient found to harbor a thoracic transdural spinal cord herniation at the disk space immediately caudal to a prior discectomy. Documentation of the radiographic progression of this patient's spinal cord herniation is presented, spanning the course of 13years. The patient underwent intradural repair of his dural defect via a lateral extracavitary approach. The herniated spinal cord was successfully reduced. The patient had modest improvement in his symptoms at 2-year follow-up. To the best of the authors' knowledge, this case represents the first reported case documenting this anomaly at a level adjacent to that of a previous surgery within the thoracic spine.

OPERATIVE TREATMENT OF ANTERIOR THORACIC SPINAL CORD HERNIATION

Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P < 0.036). Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder.

Surgical Management of Thoracic Spinal Cord Herniation

This report describes a case of spinal cord herniation (SCH) and the surgical technique used to repair the herniation. To describe a new surgical technique used to provide increased exposure to minimize spinal cord traction for safe repair of the ventral dural defect. SCH is a relatively rare pathologic condition that is frequently misdiagnosed. It is characterized by the spontaneous herniation and tethering of the spinal cord through a ventral dural defect. A limitation of current surgical management is sufficient exposure of the defect through which the cord herniates. This technique entails a posterior decompressive laminectomy and bilateral transpedicular approach, followed by unilateral removal of the pedicle and transverse processes to sufficiently expose the dural defect and SCH. A Gore-Tex graft is then used to repair the dural defect. This approach provided greater exposure of the ventral dural defect and anterior spinal cord, and allowed for safer dissection of dural adhesions. By releasing these adhesions, the spinal cord was returned to its normal position in the thecal sac. The dural defect was then repaired with minimal manipulation of the spinal cord. We present a rare case of SCH. We describe a new technique used to repair SCH, which adds to the repertoire of existing surgical techniques. By providing a wide exposure, this approach provides wide access to the ventral thecal sac, thus minimizing the requirement for cord traction and allowing for safer closure of the dural defect.

Spontaneous thoracic spinal cord herniation presenting as tethered cord syndrome

Spontaneous thoracic spinal cord herniation presenting as tethered cord syndrome

Thoracic Spinal Cord Herniation- Delayed Diagnosis is a Major Concern.

A 54 year-old man presented with 3 years of progressive left foot drop and 4 months of proximal weakness in right leg. Hypoesthesia between left T8 and T10 levels. There was 0/5 strength of left ankle dorsiflexors, invertors and evertors. There was 3/5 strength of left hamstring, iliopsoas and right extensor digitorum brevis. No abdominal reflex but brisk ankle and knee jerks. Babinski’s signs with increased tone in both lower extremities. MRI (Figure: A-F) of thoracic spine showed T5/T6 anterior thoracic spinal cord herniation. It is uncommon and often diagnosed late or misdiagnosed as a presumed posterior intradural arachnoid cyst.1,2 Prompt diagnosis and treatment can prevent severe disability. Figure 1 Figure: Pre-operative images: Sagittal spin echo T1-WI (A), FSE T2-WI (B), Axial FSE T2-WI (C) – Left anterolateral herniation (C), There is anterior displacement of the thoracic cord at T5/T6 level within the ventral epidural space abutting directly the posterior aspect of the T5/T6 disc and the corresponding vertebral body. Post-operative images: Sagittal spin echo T1-WI (D), FSE T2-WI (E), Axial FSE T2-WI (F), showing resolution of thoracic cord herniation at T5/T6 disc level with gliotic anterior cord atrophy.

Ventral Thoracic Spinal Cord Herniation: A Commonly Misdiagnosed and Treatable Cause of Myelopathy

Idiopathic ventral spinal cord herniation is a rare cause of progressive myelopathy that demonstrates unique radiological features. We describe a case of thoracic spinal cord herniation through an anterior dural defect and discuss the characteristic findings on magnetic resonance imaging and computed tomographic myelography. A 36-year-old man presented to our clinic with progressive leg weakness and spasticity in both legs. Magnetic resonance imaging of the thoracic spinal canal demonstrated C-shaped anterior kinking of an atrophied spinal cord and enlarged dorsal subarachnoid space at the T5-T6 level. Computed tomographic myelography showed ventral herniation of the spinal cord and no evidence of an intradural spinal arachnoid cyst. Ventral spinal cord herniation is a commonly misdiagnosed entity. Knowledge of the characteristic imaging appearance of this treatable condition is important for proper diagnosis and treatment.

Atypical Clinical Presentation of Idiophatic Thoracic Spinal Cord Herniation

Case report. To report an adult female patient with idiopathic spinal cord herniation presenting with pain without symptoms of myelopathy. Idiopathic spinal cord herniation is a rare but increasingly recognized cause of myelopathy that can be successfully diagnosed with the almost pathognomonic findings on magnetic resonance imaging. There are over 90 cases that were treated surgically reported in the literature. A 38-year-old woman presented with a 6-month history of chest pain radiating through to the back in bilateral T4 dermatome. Her neurologic examination was normal. Magnetic resonance study revealing ventral displacement and adherence of spinal cord at T4 level led to the diagnosis of idiopathic spinal cord herniation. Mild spinal cord atrophy with the dilatation of dorsal subarachnoid space was determined. The patient is observed-up on conservative treatment for pain. Idiopathic spinal cord herniation is 1 of the causes of unexplained atypical thoracic pain with or without signs and symptoms of myelopathy. Magnetic resonance imaging is recommended to establish the diagnosis in patients, particularly age ranged from 36 to 59, whose clinical and laboratory findings are inconclusive.

Improvement of Brown-Sequard syndrome after surgical repair of an idiopathic thoracic spinal cord herniation

Sirs: Idiopathic spinal cord herniation (ISCH) through an anterior or anterior-lateral dural defect is a rare cause for progressive myelopathy, but has become more recognized during recent years with the routine use of MRI. Nevertheless in most cases the patients present with a long lasting history of a progressive Brown-Sequard syndrome. In the following we describe our experience with the case of an ISCH, the clinical and radiological signs and the surgical therapy via dorsal foraminotomy. A 50-year-old man presented with a four year history of a slowly progressing loss of temperature and pain sensation in the sense of a Brown-Sequard syndrome in the right side of the body beginning at dermatome T 2/3 down to the level of T 5/6. For two years he had developed a more rapid progressive spastic paresis of the left leg. There were no vegetative symptoms or pain. He had no history of spinal trauma or other relevant diseases. MRI showed herniation of the spinal cord through the left ventrolateral dura at the level of T 2/3 with adherence to the dorsal spinal ligament (Fig. 1a, b). The somatosensory evoked responses showed a lesion of the dorsal column. Surgery was performed via dorsal foraminotomy at the level T 2/3. After opening of the dura numerous adhesions were removed, the spinal cord was carefully replaced into the dural sleeve and the dural defect was closed with a patch of two Gore-Tex strips from the intradural side. From the extradural side the patch was strengthened with a collagen fleece. The postoperative magnetic resonance imaging scans showed a correct position of the spinal cord without edema and the patch at T 2/3 (Fig. 2a, b). Four weeks after surgery the weakness in the patient’s left leg had significantly decreased although there was a remnant of the spastic paraparesis. The loss of temperature and pain sensation in the right leg remained unchanged. ISCH is a rare pathological entity with only about 110 cases being reported so far. The initially unspecific symptoms and the slow progression of the disease make the clinical diagnosis rather difficult. The diagnosis can be made by MRI which shows ventral displacement of the spinal cord with dorsal widening of the subarachnoid space. The etiology of the disease has been hypothesized to be congenital [5, 7], traumatic [1, 8], spontaneous [2, 4, 9], iatrogenic and inflammatory; however, no proof exists for any of these explanations. In most of the cases the affected levels range between T 4 and T 7. Many patients are of middle age with a female predominance. In the beginning the symptoms are unspecific. The symptoms progress slowly over years. In more than 70 % a slowly progressing Brown-Sequard syndrome or spastic asymmetric paraparesis can be found. Only a few cases reported in the literature were treated conservatively [1, 3, 6]. These patients refused surgery LETTER TO THE EDITORS

Idiopathic Spinal Cord Herniation as a Treatable Cause of Progressive Brown-Sequard Syndrome

Idiopathic spinal cord herniation is a rare spinal cord disorder caused by spinal cord prolapse through a adural defect. It is a curable disease, so early detection is of particular importance. We report a 38-year-old woman with Brown-Sequard syndrome which was caused by the thoracic spinal cord herniation. Her weakness was almost completely resolved after surgical management, which emphasizes the importance of early diagnosis and surgical management in this rare disease entity.

Images In Neurology: Spinal Cord Herniation In A Patient With Brown Sequard Syndrome

A 44-year-old female patient was alright till two years back when she noticed insidious onset of decreased pain sensation of the whole of right lower limb. She did not have any motor weakness, back ache, bladder symptoms or altered gait at that time. Magnetic resonance imaging (MRI) of the spinal cord at this time was interpreted as disc herniation in the cervical region and she was managed conservatively. Over the next 2 years she developed gradually progressive weakness of the distal muscles of the left lower limb and later involving proximal muscles. This was followed by urgency of micturition, with preserved bladder sensations. She was subsequently investigated with an MRI that revealed a thoracic spinal cord herniation

P27.5 Motor evoked potentials in three cases of thoracic idiopathic spinal cord herniation

P27.5 Motor evoked potentials in three cases of thoracic idiopathic spinal cord herniation

Modified Surgical Technique for the Treatment of Idiopathic Spinal Cord Herniation

Spinal cord herniation is not a common disease and only 80 cases have been reported to the best of our knowledge. The treatment of this lesion is thought to be difficult and a better surgical technique has not been established. A 57-year-old man presented with gradually worsening spastic gait and hypoesthesia in the bilateral lower extremities suspected to be due to Brown-Séquard syndrome. Magnetic resonance imaging showed a thoracic spinal cord herniation into the anterior hiatus at T2 - 3. A modified technique of closure of the hiatus in front of the herniation was performed. A surgical artificial dural membrane was introduced between the herniated portion of the thoracic cord and the dural hiatus and was placed to cover the whole dural defect in order to minimize the operative procedure at the ventral side of the spinal cord. On subsequent magnetic resonance imaging, the herniation was remarkably improved and patient's symptoms were abolished. The direct widening of the dural defect has been reported to be the only treatment providing a good outcome. We suggest that our modified technique for its closure can be as safe and effective as the direct widening method.

Spontaneous Thoracic Spinal Cord Herniation: Three Cases with Long-term Follow-up

Spontaneous thoracic spinal cord herniation (STSCH) is an uncommon cause of thoracic myelopathy. Fewer than 40 cases have been reported in the English language literature with a mean follow-up of less than 6 months. We have encountered three patients diagnosed with STSCH in the last 6 years at our institution. These patients presented with symptoms and signs localizing to the thoracic spinal cord. Magnetic resonance imaging revealed ventral thoracic spinal cord displacement in each. One patient was treated surgically, two managed expectantly. Two patients have been followed for greater than 5 years, whereas a third has been followed for 15 months. Our experience suggests that patients with neurological symptoms and signs attributable to STSCH may not progress and therefore may be followed with clinical and magnetic resonance imaging surveillance. When surgery is indicated for progressive STSCH, late retethering may occur.

MR imaging features of idiopathic thoracic spinal cord herniations using combined 3D-fiesta and 2D-PC cine techniques

Idiopathic thoracic spinal cord herniation (TISCH) is a rare cause of surgically treatable progressive myelopathy. The authors report 3 cases of TISCH diagnosed based on conventional T1- and T2-weighted Spin-Echo (SE) MR images in one case, and T1- and T2-weighted SE images combined with 3D-FIESTA (Fast Imaging Employing Steady state Acquisition) and 2D-Phase-Contrast Cine MR imaging in 2 cases. Conventional MRI findings usually provided the diagnosis. 3D-FIESTA images confirmed it, showing the herniated cord in the ventral epidural space. Moreover, in combination with 2D-Phase Contrast cine technique, it was a sensitive method to for the detection of associated pre- or postoperative cerebrospinal fluid spaces abnormalities.

Upper thoracic spinal cord herniation after traumatic nerve root avulsion

✓ Transdural herniation of the spinal cord, a rare but well-documented entity, has been reported sporadically for more than 25 years as a possible cause for various neurological signs and symptoms ranging from isolated sensory or motor findings to myelopathy and Brown–Séquard syndrome. The authors report, to the best of their knowledge, the first case of upper thoracic spinal cord herniation occurring after traumatic nerve root avulsion.

Case of idiopathic thoracic spinal cord herniation with a chronic history: a case report and review of the literature

Idiopathic spinal cord herniation is a rare disease that presents with slowly progressive myelopathy. This article describes the clinical findings of a patient with a chronic history. A 68-year-old woman initially presented at the age of 32 years with left leg weakness. After slowly progressive neurological deterioration over 34 years, she became completely paraplegic. At the age of 66 years, magnetic resonance imaging resulted in a diagnosis of idiopathic spinal cord herniation at the T6/7 level. Surgery was performed to reduce aching of the lower extremities. The spinal cord was released from the dural defect through a T5–T8 laminectomy. The dural defect was enlarged by resecting its periphery to prevent reherniation of the spinal cord. After the surgery, pain in the lower extremities resolved and her motor function slightly improved. Although operative treatment is naturally recommended at the early stage of this disease, our case suggests that some symptoms can be resolved by surgical treatment despite prolonged, severe preoperative symptoms.

特発性脊髄ヘルニアの２症例

Idiopathic herniation of the spinal cord is a rare desease. We report two cases of thoracic idiopathic spinal cord herniation in a 64-year-old woman and a 63-year-old woman showing thoracic myelopathy. MRI and CTM were useful for diagnosing this disorder. After repairing the herniation, neurologic deficients improved in both patients.

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.