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Spinal cord herniation with characteristic bone change: a case report.

Imai T, Nakane Y, Tachibana E, Ogura K - Nagoya J Med Sci (2015)

Bottom Line: A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented.Postoperatively, the patient experienced gradual improvement in neurologic function.The SCH mechanism and surgical strategy are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Japan.

ABSTRACT
Spinal cord herniation (SCH) is a rare disease characterized by herniation of the thoracic spinal cord through an anterior dural defect, presenting with progressive myelopathy. A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented. The strangled spinal cord was released, and the defect was closed microsurgically using an artificial dural patch to prevent re-herniation. Postoperatively, the patient experienced gradual improvement in neurologic function. The SCH mechanism and surgical strategy are discussed.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph with laceration of the dura mater and bone defectVertebral bone (white arrow) and bone defect (black arrow) with suction tube, and laceration of the dura mater (arrow heads).
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fig3: Intraoperative photograph with laceration of the dura mater and bone defectVertebral bone (white arrow) and bone defect (black arrow) with suction tube, and laceration of the dura mater (arrow heads).

Mentions: A 69-year-old woman presented with progressive weakness of the right leg and limping over a period of three years. She reported an episode of falling from a stepladder, but described the trauma as mild and noted that it occurred 10 years ago. She had no history of spinal surgery. Neurological examination revealed spastic monoparesis of the right leg with acceleration of ankle clonus and an exaggerated deep tendon reflex. She could not walk more than 20 meters. She had loss of vibratory and position sense below the T4 level on the right side, combined with contralateral loss of pain and temperature sensation, typical of Brown-Sequard syndrome below the level of T4. Her bowel and bladder functions were normal. MRI showed focal thoracic cord pulling out from the epidural space and tethering ventrally through the dural defect at the edge of the T4 vertebral body level (Figure 1). CT myelography demonstrated an osteophyte that made a hemisphere-like cavity, and the spinal cord was herniated into the cavity. The cerebrospinal fluid (CSF) signal disappeared on the ventral side of the herniated lesion (Figure 2). Laminectomy was performed, along with intradural exploration of the spinal cord. The cord was herniated into the depressed region of the vertebral bone. The herniated part of the spinal cord was released microsurgically and redressed intradurally. The bone defect and laceration of the dura mater were seen, and duplication of the dura mater could not be identified (Figure 3). The laceration length was approximately 1.2 cm longitudinally. Additionally, a dural patch (polytetrafluoroethylene 10 mm×15 mm) was inserted to cover the dural defect, ventral to the spinal cord, to prevent re-herniation. The patch was held in place with stay sutures and 3 stitches each on both sides. A transient reduction in the voltage of motor evoked potentials during surgery was observed while the tethering of the cord was released, but it returned to normal baseline by the end of the operation. The patient’s motor weakness improved gradually, and she was able to walk with a cane over 50 meters one week after the operation. Temperature sensation of her left leg returned to normal two weeks after operation. A postoperative MRI showed improvement of the ventral displacement of the spinal cord (Figure 4).


Spinal cord herniation with characteristic bone change: a case report.

Imai T, Nakane Y, Tachibana E, Ogura K - Nagoya J Med Sci (2015)

Intraoperative photograph with laceration of the dura mater and bone defectVertebral bone (white arrow) and bone defect (black arrow) with suction tube, and laceration of the dura mater (arrow heads).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4574340&req=5

fig3: Intraoperative photograph with laceration of the dura mater and bone defectVertebral bone (white arrow) and bone defect (black arrow) with suction tube, and laceration of the dura mater (arrow heads).
Mentions: A 69-year-old woman presented with progressive weakness of the right leg and limping over a period of three years. She reported an episode of falling from a stepladder, but described the trauma as mild and noted that it occurred 10 years ago. She had no history of spinal surgery. Neurological examination revealed spastic monoparesis of the right leg with acceleration of ankle clonus and an exaggerated deep tendon reflex. She could not walk more than 20 meters. She had loss of vibratory and position sense below the T4 level on the right side, combined with contralateral loss of pain and temperature sensation, typical of Brown-Sequard syndrome below the level of T4. Her bowel and bladder functions were normal. MRI showed focal thoracic cord pulling out from the epidural space and tethering ventrally through the dural defect at the edge of the T4 vertebral body level (Figure 1). CT myelography demonstrated an osteophyte that made a hemisphere-like cavity, and the spinal cord was herniated into the cavity. The cerebrospinal fluid (CSF) signal disappeared on the ventral side of the herniated lesion (Figure 2). Laminectomy was performed, along with intradural exploration of the spinal cord. The cord was herniated into the depressed region of the vertebral bone. The herniated part of the spinal cord was released microsurgically and redressed intradurally. The bone defect and laceration of the dura mater were seen, and duplication of the dura mater could not be identified (Figure 3). The laceration length was approximately 1.2 cm longitudinally. Additionally, a dural patch (polytetrafluoroethylene 10 mm×15 mm) was inserted to cover the dural defect, ventral to the spinal cord, to prevent re-herniation. The patch was held in place with stay sutures and 3 stitches each on both sides. A transient reduction in the voltage of motor evoked potentials during surgery was observed while the tethering of the cord was released, but it returned to normal baseline by the end of the operation. The patient’s motor weakness improved gradually, and she was able to walk with a cane over 50 meters one week after the operation. Temperature sensation of her left leg returned to normal two weeks after operation. A postoperative MRI showed improvement of the ventral displacement of the spinal cord (Figure 4).

Bottom Line: A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented.Postoperatively, the patient experienced gradual improvement in neurologic function.The SCH mechanism and surgical strategy are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Japan.

ABSTRACT
Spinal cord herniation (SCH) is a rare disease characterized by herniation of the thoracic spinal cord through an anterior dural defect, presenting with progressive myelopathy. A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented. The strangled spinal cord was released, and the defect was closed microsurgically using an artificial dural patch to prevent re-herniation. Postoperatively, the patient experienced gradual improvement in neurologic function. The SCH mechanism and surgical strategy are discussed.

No MeSH data available.


Related in: MedlinePlus