TY - JOUR
T1 - Symptomatic thoracic spinal cord herniation
T2 - Case series and technical report
AU - Hawasli, Ammar H.
AU - Ray, Wilson Z.
AU - Wright, Neill M.
N1 - Publisher Copyright:
© 2014 by the Congress of Neurological Surgeons.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Background and importance: Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. CLINICAL PRESENTATION: In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. CONCLUSION: Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.
AB - Background and importance: Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. CLINICAL PRESENTATION: In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. CONCLUSION: Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.
KW - Idiopathic thoracic spinal cord herniation
KW - Myelopathy
UR - http://www.scopus.com/inward/record.url?scp=84926079780&partnerID=8YFLogxK
U2 - 10.1227/NEU.0000000000000437
DO - 10.1227/NEU.0000000000000437
M3 - Article
C2 - 24871148
AN - SCOPUS:84926079780
SN - 2332-4252
VL - 10
SP - E498-E504
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 3
ER -