Department of Neurosurgery, Yokohama Brain and Spine Center, l-2-1 Takigashira, Isogo-ku, Yokohama, Kanagawa, 235-0012, Japan.
Department of Spinal Surgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan.
Eur Spine J. 2019 Feb;28(2):298-305. doi: 10.1007/s00586-017-5147-y. Epub 2017 Jun 7.
We present a patient with idiopathic spinal cord herniation (ISCH) whose dura mater was histopathologically examined to elucidate its pathogenesis.
A 33-year-old previously healthy man presented with progressive walking difficulty, spasticity of the right lower leg, and hyperesthesia below the right chest. Neuroimaging revealed right ventral displacement of the spinal cord at T5-6. The diagnosis was ISCH and he underwent release of the herniation from the ventral dural opening. Dural biopsy at the edge of the ventral opening and in the dorsal durotomy was performed. Postoperatively, his gait was improved. Histopathological examination of the ventral dural specimen showed non-specific degeneration, i.e., loose arrangements of collagen fibers, edematous changes, minor inflammatory cell infiltration, and angiogenesis. The specimen from the dorsal durotomy was normal.
It is unclear whether the observed degeneration besides the ventral opening was the primary cause of ISCH or reflected secondary changes resulting from cumulative damage due to pulsation of the herniated spinal cord. However, the degeneration limited to the ventral opening suggests that ISCH was a local event in an individual with a normal dural theca.
我们报告了一例特发性脊髓脊膜膨出（ISCH）患者，对其硬脊膜进行了组织病理学检查，以阐明其发病机制。
一名 33 岁既往健康的男性出现进行性行走困难、右小腿痉挛和右胸以下感觉过敏。神经影像学显示 T5-6 处脊髓右侧腹侧移位。诊断为 ISCH，行硬脊膜腹侧开口疝松解术。术后，他的步态得到改善。腹侧硬脊膜标本的组织病理学检查显示非特异性变性，即胶原纤维排列疏松、水肿改变、少量炎症细胞浸润和血管生成。背侧硬脊膜切开术标本正常。
尚不清楚观察到的腹侧开口以外的变性是 ISCH 的主要原因，还是由于脊髓疝搏动引起的累积损伤导致的继发变化。然而，仅局限于腹侧开口的变性表明，在一个硬脊膜正常的个体中，ISCH 是一个局部事件。
