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Table of Contents    
LETTER TO EDITOR
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1472-1474

A Rare Entity: Idiopathic Spinal Cord Herniation


1 Department of Neurosurgery, Istanbul Medicine Hospital, Istanbul, Turkey
2 Department of Neurosurgery, Istanbul Education and Research Hospital, Istanbul, Turkey
3 Department of Neurosurgery, Usak University Education and Research Hospital, Usak, Turkey

Date of Web Publication19-Dec-2020

Correspondence Address:
Dr. Hakan Yilmaz
Department of Neurosugery, Usak University Education and Resarch Hospital, Usak
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.304129

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How to cite this article:
Dogu H, Ozdemir NG, Yilmaz H, Turk O, Demirel N, Atci IB, Kocak A. A Rare Entity: Idiopathic Spinal Cord Herniation. Neurol India 2020;68:1472-4

How to cite this URL:
Dogu H, Ozdemir NG, Yilmaz H, Turk O, Demirel N, Atci IB, Kocak A. A Rare Entity: Idiopathic Spinal Cord Herniation. Neurol India [serial online] 2020 [cited 2021 Jan 27];68:1472-4. Available from: https://www.neurologyindia.com/text.asp?2020/68/6/1472/304129




Sir,

Idiopathic spinal cord herniation is a rare disease of middle-aged patients presenting with myelopathy. Displacement of the spinal cord is through a ventral dural defect. Surgery is the treatment of choice with different techniques ranging from direct closure to using a patch as a dural substitute.[1],[2]

A 72-year-old woman complaining of progressive walking difficulty, weakness of the lower extremities, and urinary incontinence was admitted to the hospital. On her neurological examination, the patient was paraparetic (right: 2/5, left: 3/5). Deep tendon reflexes were hyperactive and she were urinarily incontinent. Magnetic resonance imaging (MRI) revealed focal anterior kinking at the level of T7-8 and the cord were thinned. The posterior extramedullary space was enlarged [Figure 1], [Figure 2].
Figure 1: Preoperative sagittal T2-weighted MRI: anterior kinking and atrophy of the spinal cord at T7-8 level (red arrow), subarachnoid space is enlarged

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Figure 2: Preoperative T2-weighted axial MRI: ventral displacement of the spinal cord

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The patient was operated. Large laminectomy with microneurosurgical dentate ligament resection was performed and the spinal cord was repositioned after dural defect reparation with an allograft.

Postoperatively her paraparesis was relieved. Her postoperative MRI showed the cord was repositioned [Figure 3]a, [Figure 3]b. After three weeks, she began to ambulate with support and she was referred for physical therapy.
Figure 3: (a, b): Postoperative sagittal and axial T2-weighted MRI: in the early postoperative period the cord is observed to be repositioned, although partial ventral apposition persists

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Idiopathic spinal cord herniation is recognized as herniation of the spinal cord through a ventral or ventrolateral defect. Including our case, 131 patients were reviewed [Table 1]. Most frequently diagnosed between levels T3 and T7. Clinic presentation is usually as Brown-Sequard syndrome. Other presentations are monoparesis, paraparesis, sensory impairment, bowel and bladder dysfunction, impotence, and chest and back pain.[2] T4-5 is reported to be the most frequently involved level.[3] The etiology of the ventral dural defect may be idiopathic, due to trauma or iatrogenic. Pathophysiology is not thoroughly known though multiple theories have been reported. The dorsal arachnoid cyst was reported to transmit pressure from the spinal cord causing the ventral defect. MRI showed anterior kinking of the thoracic spinal cord with dorsal subarachnoid enlargement.[3]
Table 1: Including our case, 131 patients were reviewed

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Treatment is the surgical reduction of the spinal cord and repositioning of the cord to its normal anatomic position with dural patch repair. Technically, laminectomy, dorsal durotomy with sectioning of the adhesions, and dentate ligaments are required.[4] Our patient has been surgically treated for thoracic spinal cord herniation with the dural repair.

The pathogenesis of thoracic spinal cord herniation is not fully understood. Trauma due to osteophytes or calcified discs may be one of the initiating factors. Since the disease is uncommon, one must be careful about misdiagnosis. Spinal cord reposition with dural repairment may give relief in progressive myelopathic patients.

Declaration of patient consent

Written informed consent for submission of the paper was obtained from the patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Najjar MW, Baeesa SS, Lingawi SS. Idiopathic spinal cord herniation: A new theory of pathogenesis. Surg Neurol 2004;62:161-70.  Back to cited text no. 1
    
2.
Sasani M, Ozer AF, Vural M, Sarioglu AC. Idiopathic spinal cord herniation: Case report and review of the literature. J Spinal Cord Med 2009;32:86-94.  Back to cited text no. 2
    
3.
Alkhamees A, Proust F. Idiopathic spinal cord herniation: A case report. Int J Health Sci (Qassim) 2016;10:592-5.  Back to cited text no. 3
    
4.
Brus-RamerM, Dillon WP. Idiopathic thoracic spinal cord herniation: Retrospective analysis supporting a mechanism of diskogenic dural injury and subsequent tamponade. AJNR Am J Neuroradiol 2012;33:52-6.  Back to cited text no. 4
    


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