Yamamoto Norio, Katoh Shinsuke, Higashino Kousaku, Sairyo Koichi
Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan.
Int J Spine Surg. 2014 Dec 1;8. doi: 10.14444/1029. eCollection 2014.
Idiopathic spinal cord herniation (ISCH) is a rare condition and its pathogenesis remains unclear. The purpose of this case report is to present an ISCH case with dorsal subarachnoid septum suggesting the pathogenesis of ISCH being adhesions from preexisting inflammation.
Single case report.
A 60-year-old woman presented with Brown-Séquard syndrome below the level of T6. Magnetic resonance imaging revealed the thoracic spinal cord was displaced ventrally, and the dorsal subarachnoid space was enlarged and had a septum between the spinal cord and dura mater. Intraoperatively, the dorsal dura mater was seen to be adherent and the subarachnoid septum was identified after durotomy. The inner layer defect of the duplicated dura mater was found in the ventral dura mater, through which the spinal cord had herniated. After releasing the septum, the adhesions around the dura mater, and the hiatus, the spinal cord was reduced.
The present case indicates that adhesions around the dura mater can be the pathogenesis of ISCH.
特发性脊髓疝（ISCH）是一种罕见疾病，其发病机制尚不清楚。本病例报告的目的是呈现一例伴有背侧蛛网膜隔的ISCH病例，提示ISCH的发病机制是既往炎症引起的粘连。
单病例报告。
一名60岁女性在T6水平以下出现布朗-塞卡尔综合征。磁共振成像显示胸段脊髓腹侧移位，背侧蛛网膜下腔扩大，脊髓与硬脑膜之间有一个隔膜。术中可见背侧硬脑膜粘连，切开硬脑膜后发现蛛网膜隔。在腹侧硬脑膜中发现了双层硬脑膜的内层缺损，脊髓通过该缺损疝出。松解隔膜、硬脑膜周围的粘连及裂孔后，脊髓复位。
本病例表明硬脑膜周围的粘连可能是ISCH的发病机制。
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