Abstract
Idiopathic spinal cord herniation (ISCH) is a rare spinal disease, in which chronic cerebrospinal fluid pulsations push the arachnoid and adjacent thoracic spinal cord region through an antero-lateral dural defect of congenital, post-traumatic, or inflammatory/erosive origin. Symptomatic patients commonly present around the 5th decade of life with slowly progressive myelopathy. Diagnosis relies on high-resolution magnetic resonance imaging. Stable mild cases may be observed, whereas in progressive symptomatic situations, surgical spinal cord reposition and dural defect repair with a dural patch is the preferred treatment. We present a case of ISCH at T5/6 and a review the literature.
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Comment
Herniation of the spinal cord is a rarely encountered cause of myelopathy. The most common manifestation at thoracic level is the Brown-Sequard syndrome from an anterior cord herniation, occurring spontaneously or after trauma. Dorsally directed cord herniation characteristically also occurs, as a result of previous surgery, at cervical levels and may include radicular symptoms. A delay of several years to decades between the clinical presentation and any antecedent trauma or spinal surgery should be taken into account. Deficits are progressive and, with surgical intervention, recovery is often excellent. Imaging studies show typical, even though often overlooked signs suggestive of transdural spinal cord herniation, including: a small rotated portion of the spinal cord displaced ventrally or dorsally at the thoracolumbar levels, or displaced dorsally at the cervical level, and a perilesional communicating, apparently dilated, CSF space.
The authors here present a case successfully treated and thoroughly review the pertinent literature. This manuscript also provides interesting illustrations and practical suggestions on the management of this rare condition.
Alfredo Conti
Messina, Italy
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Payer, M., Zumsteg, D., De Tribolet, N. et al. Surgical management of thoracic idiopathic spinal cord herniation. Technical case report and review. Acta Neurochir 158, 1579–1582 (2016). https://doi.org/10.1007/s00701-016-2840-2
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DOI: https://doi.org/10.1007/s00701-016-2840-2