Hassler Werner, Al-Kahlout Eyad, Schick Uta
Department of Neurosurgery, Wedau Kliniken, Duisburg, Germany.
J Neurosurg Spine. 2008 Nov;9(5):438-43. doi: 10.3171/SPI.2008.9.11.438.
The authors report on a series of 10 patients with spontaneous thoracic cord herniation, provide the longterm follow-up, and propose a surgical strategy.
All 10 patients had a defect in the ventral dura mater. They were all treated surgically with wide excision of the dura around the defect, repositioning of the cord, and reconstruction with a ventral patch. Five patients were followed up for > 4 years.
Surgery improved motor power in 4 patients and pain in 2 patients, although sensory disturbances remained unchanged in all but 1 patient. One patient's condition deteriorated secondarily due to edema and syringomyelia.
Microsurgical treatment may halt the exacerbation of neurological symptoms and should be performed with progressive deficits. Long-term results are good regarding the motor function.
作者报告了一系列10例自发性胸段脊髓疝患者，提供了长期随访结果，并提出了一种手术策略。
所有10例患者均存在腹侧硬脊膜缺损。他们均接受了手术治疗，包括广泛切除缺损周围的硬脊膜、脊髓复位以及使用腹侧补片进行重建。5例患者随访时间超过4年。
手术使4例患者的运动能力得到改善，2例患者的疼痛得到缓解，不过除1例患者外，所有患者的感觉障碍均未改变。1例患者因水肿和脊髓空洞症病情继发恶化。
显微手术治疗可能会阻止神经症状的加重，对于进行性神经功能缺损患者应实施该手术。就运动功能而言，长期效果良好。
