Spinal cord herniation after brachial plexus injury.

BACKGROUND

Spinal cord herniation (SCH) is an uncommon cause of myelopathy. Documented trauma is a rare cause, and most cases are idiopathic. One special type of trauma that may lead to SCH is a brachial plexus injury. We report a case of SCH with delayed neurological symptoms after a brachial plexus injury. We reviewed the literature and illustrated the closing technique as described by Batzdorf.

CASE DESCRIPTION

Following a motor vehicle accident, a 27-year-old male sustained a brachial plexus injury and multiple left-sided nerve root avulsions (C6, C7, and C8) resulting into a full paralysis of the left arm. There was also a loss of pain and temperature sensation on the right side of the body. He underwent reconstructive surgery without any functional improvement. After 6 to 7 years his condition worsened. Magnetic resonance imaging revealed a left-sided SCH at the level of C7. He underwent a C6-C7 laminectomy which revealed a pseudomeningocele at C6-C7 accompanied by focal SCH at the location of the C7 root. The SCH was reduced intradurally and the dural defect of the meningocele was covered with a Neuropatch membrane wrapped around the spinal cord (between the spinal cord and the dura) according to the technique described by Batzdorf. Postoperatively, the neurological symptoms improved.

CONCLUSION

SCH should be surgically repaired utilizing the technique described by Batzdorf if further neurological deficits develop.