Guppy Kern H, Silverthorn James W
Department of Neurosurgery, The Kaiser Permanente Medical Group, Sacramento, California, USA.
Department of Neurosurgery, The Kaiser Permanente Medical Group, Sacramento, California, USA.
World Neurosurg. 2017 Apr;100:711.e7-711.e12. doi: 10.1016/j.wneu.2017.01.078. Epub 2017 Feb 1.
Spinal cord herniation (SCH) is rare, is mostly idiopathic, and occurs predominantly in the thoracic spine. SCH is less common in the cervical spine and has been reported after posterior cervical spine surgery associated with the development of pseudomeningoceles. Two cases of SCH have been reported after anterior cervical corpectomies for ossified posterior longitudinal ligament with cerebrospinal fluid (CSF) leaks. We report the third such case, but the first in a patient without ossified posterior longitudinal ligament (degenerative disc disease and pseudarthrosis).
A 56-year-old woman presented with bilateral arm pain and weakness. She had undergone 3 previous anterior cervical spine surgeries at an outside medical center with the most recent 7 years ago with C5 and C6 corpectomies and fusion with a persistent CSF leak. Magnetic resonance imaging and computed tomography myelography showed spinal cord herniation through the mesh cage at C6. The patient underwent a redo C5 and C6 corpectomy with untethering of the spinal cord. The patient was asymptomatic 2 years later.
This is the first reported case of anterior cervical SCH in a patient without ossified posterior longitudinal ligament after multiple anterior cervical fusions including a cervical corpectomy for pseudarthrosis with a CSF leak. We hypothesize that persistent CSF leak causes a pressure gradient across the dura mater through the cage to the lower pressure in the retropharyngeal space, which led to herniation of the spinal cord into the anterior cage. We review the literature and discuss the treatment choices for anterior cervical SCH.
脊髓疝（SCH）较为罕见，多为特发性，主要发生于胸椎。SCH在颈椎较少见，曾有报道称其发生于颈椎后路手术后并发假性脑脊膜膨出时。也有两例在颈椎前路椎体次全切除术后出现脊髓疝，伴有脑脊液（CSF）漏，患者存在后纵韧带骨化。我们报道第三例此类病例，但首例患者并无后纵韧带骨化（退行性椎间盘疾病和假关节形成）。
一名56岁女性，出现双侧手臂疼痛及无力症状。她曾在外部医疗中心接受过3次颈椎前路手术，最近一次手术是在7年前，进行了C5和C6椎体次全切除及融合术，术后持续存在脑脊液漏。磁共振成像和计算机断层扫描脊髓造影显示脊髓通过C6处的椎间融合器疝出。患者接受了再次C5和C6椎体次全切除术，并松解脊髓。两年后患者无症状。
这是首例报道的在多次颈椎前路融合术后（包括因假关节形成并伴有脑脊液漏而进行的颈椎椎体次全切除术）出现的无后纵韧带骨化患者的颈椎前路脊髓疝。我们推测持续的脑脊液漏导致硬脑膜内外形成压力梯度，脑脊液通过椎间融合器流向咽后间隙的较低压力区，从而致使脊髓疝入前路椎间融合器内。我们回顾了相关文献并讨论了颈椎前路脊髓疝的治疗选择。
