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Idiopathic ventral spinal cord herniation: an increasingly recognized cause of thoracic myelopathy.

Berg-Johnsen J, Ilstad E, Kolstad F, Züchner M, Sundseth J - J Cent Nerv Syst Dis (2014)

Bottom Line: ISCH is probably a more common cause of thoracic myelopathy than previously recognized.The patients usually develop progressive myelopathy for several years before the correct diagnosis is made.Early diagnosis is important in order to treat the patients before the myelopathy has become advanced.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

ABSTRACT
Idiopathic spinal cord herniation (ISCH), where a segment of the spinal cord has herniated through a ventral defect in the dura, is a rarely encountered cause of thoracic myelopathy. The purpose of our study was to increase the clinical awareness of this condition by presenting our experience with seven consecutive cases treated in our department since 2005. All the patients developed pronounced spastic paraparesis or Brown-Séquard syndrome for several years (mean, 4.7 years) prior to diagnosis. MRI was consistent with a transdural spinal cord herniation in the mid-thoracic region in all the cases. The patients underwent surgical reduction of the herniated spinal cord and closure of the dural defect using an artificial dural patch. At follow-up, three patients experienced considerable clinical improvement, one had slight improvement, one had transient improvement, and two were unchanged. Two of the four patients with sphincter dysfunction regained sphincter control. MRI showed realignment of the spinal cord in all the patients. ISCH is probably a more common cause of thoracic myelopathy than previously recognized. The patients usually develop progressive myelopathy for several years before the correct diagnosis is made. Early diagnosis is important in order to treat the patients before the myelopathy has become advanced.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view: (A) before surgical reduction shows the ventral spinal cord incarcerated in a sharp oval dural defect. (B) the herniated lobule has been reduced against the major cord surface, but the lobule does not flatten into the cord. (C) a synthetic dural patch has been placed ventral to the spinal cord and secured with stitches on both sides.
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f3-jcnsd-6-2014-085: Intraoperative view: (A) before surgical reduction shows the ventral spinal cord incarcerated in a sharp oval dural defect. (B) the herniated lobule has been reduced against the major cord surface, but the lobule does not flatten into the cord. (C) a synthetic dural patch has been placed ventral to the spinal cord and secured with stitches on both sides.

Mentions: Dura was opened in the midline exposing an enlarged posterior arachnoid space. The dentate ligaments were cut to mobilize the spinal cord and locate the ventral dural defect (Fig. 3A). The spinal cord was attached ventrally and seemed slightly atrophic at the herniation level. The arachnoid was detached around the defect, and the herniated lobule of the spinal cord was repositioned in the dural sac (Fig. 3B). To cover the dural defect, a synthetic dural patch was passed ventral to the spinal cord and fixed with stitches to avoid displacement (Fig. 3C). The dura was sutured and covered with tissue glue. The wound was closed without drainage in order to avoid CSF leakage.


Idiopathic ventral spinal cord herniation: an increasingly recognized cause of thoracic myelopathy.

Berg-Johnsen J, Ilstad E, Kolstad F, Züchner M, Sundseth J - J Cent Nerv Syst Dis (2014)

Intraoperative view: (A) before surgical reduction shows the ventral spinal cord incarcerated in a sharp oval dural defect. (B) the herniated lobule has been reduced against the major cord surface, but the lobule does not flatten into the cord. (C) a synthetic dural patch has been placed ventral to the spinal cord and secured with stitches on both sides.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4196882&req=5

f3-jcnsd-6-2014-085: Intraoperative view: (A) before surgical reduction shows the ventral spinal cord incarcerated in a sharp oval dural defect. (B) the herniated lobule has been reduced against the major cord surface, but the lobule does not flatten into the cord. (C) a synthetic dural patch has been placed ventral to the spinal cord and secured with stitches on both sides.
Mentions: Dura was opened in the midline exposing an enlarged posterior arachnoid space. The dentate ligaments were cut to mobilize the spinal cord and locate the ventral dural defect (Fig. 3A). The spinal cord was attached ventrally and seemed slightly atrophic at the herniation level. The arachnoid was detached around the defect, and the herniated lobule of the spinal cord was repositioned in the dural sac (Fig. 3B). To cover the dural defect, a synthetic dural patch was passed ventral to the spinal cord and fixed with stitches to avoid displacement (Fig. 3C). The dura was sutured and covered with tissue glue. The wound was closed without drainage in order to avoid CSF leakage.

Bottom Line: ISCH is probably a more common cause of thoracic myelopathy than previously recognized.The patients usually develop progressive myelopathy for several years before the correct diagnosis is made.Early diagnosis is important in order to treat the patients before the myelopathy has become advanced.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

ABSTRACT
Idiopathic spinal cord herniation (ISCH), where a segment of the spinal cord has herniated through a ventral defect in the dura, is a rarely encountered cause of thoracic myelopathy. The purpose of our study was to increase the clinical awareness of this condition by presenting our experience with seven consecutive cases treated in our department since 2005. All the patients developed pronounced spastic paraparesis or Brown-Séquard syndrome for several years (mean, 4.7 years) prior to diagnosis. MRI was consistent with a transdural spinal cord herniation in the mid-thoracic region in all the cases. The patients underwent surgical reduction of the herniated spinal cord and closure of the dural defect using an artificial dural patch. At follow-up, three patients experienced considerable clinical improvement, one had slight improvement, one had transient improvement, and two were unchanged. Two of the four patients with sphincter dysfunction regained sphincter control. MRI showed realignment of the spinal cord in all the patients. ISCH is probably a more common cause of thoracic myelopathy than previously recognized. The patients usually develop progressive myelopathy for several years before the correct diagnosis is made. Early diagnosis is important in order to treat the patients before the myelopathy has become advanced.

No MeSH data available.


Related in: MedlinePlus