Samuel Nardin, Goldstein Christina L, Santaguida Carlo, Fehlings Michael G
University of Toronto;
Division of Orthopedic Surgery, University of Toronto;
J Neurosurg Spine. 2015 Sep;23(3):306-8. doi: 10.3171/2014.12.SPINE14950. Epub 2015 May 29.
Spinal cord herniation is a relatively rare but increasingly recognized clinical entity, with fewer than 200 cases reported in the literature to date. The etiology of this condition remains unknown, and surgery is used as the primary treatment to correct the herniation and consequent spinal cord compromise. Some patients without clinical progression have been treated with nonoperative measures, including careful follow-up and symptomatic physical therapy. To date, however, there has been no published report on the resolution of spinal cord herniation without surgical intervention. The patient in the featured case is a 58-year-old man who presented with mild thoracic myelopathy and imaging findings consistent with idiopathic spinal cord herniation. Surprisingly, updated MRI studies, obtained to better delineate the pathology, showed spontaneous resolution of the herniation. Subsequent MRI 6 months later revealed continued resolution of the previous spinal cord herniation. This is the first report of spontaneous resolution of a spinal cord herniation in the literature. At present, the treatment of this disorder is individualized, with microsurgical correction used in patients with progressive neurological impairment. The featured case highlights the potential variability in the natural history of this condition and supports considering an initial trial of nonoperative management for patients with mild, nonprogressive neurological deficits.
脊髓疝是一种相对罕见但越来越受到认可的临床病症，迄今为止文献报道的病例不足200例。这种病症的病因尚不清楚，手术是纠正疝和随之而来的脊髓受压的主要治疗方法。一些没有临床进展的患者接受了非手术治疗，包括密切随访和对症物理治疗。然而，迄今为止，尚无关于未经手术干预而脊髓疝得以缓解的报道。该典型病例的患者是一名58岁男性，表现为轻度胸段脊髓病，影像学检查结果符合特发性脊髓疝。令人惊讶的是，为更好地描绘病变而进行的最新MRI研究显示，疝已自行缓解。6个月后的后续MRI显示先前的脊髓疝持续缓解。这是文献中关于脊髓疝自行缓解的首例报道。目前，这种疾病的治疗是个体化的，对于有进行性神经功能损害的患者采用显微手术矫正。该典型病例突出了这种病症自然病程的潜在变异性，并支持对轻度、非进行性神经功能缺损的患者首先考虑进行非手术治疗试验。
