Bamps Sven, Put Eric, Soors Peter, Bruno Termote, Calenbergh Frank Van
Department of Neurosurgery, University Hospital Leuven, Belgium.
Department of Neurosurgery, Jessa Hospital Hasselt, Belgium.
Surg Neurol Int. 2017 Dec 27;8:305. doi: 10.4103/sni.sni_329_17. eCollection 2017.
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.
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.
SCH should be surgically repaired utilizing the technique described by Batzdorf if further neurological deficits develop.
脊髓疝（SCH）是脊髓病的一种罕见病因。有记录的创伤是一种罕见病因，大多数病例为特发性。一种可能导致SCH的特殊创伤类型是臂丛神经损伤。我们报告一例臂丛神经损伤后出现延迟性神经症状的脊髓疝病例。我们回顾了相关文献，并阐述了巴茨多夫所描述的闭合技术。
一名27岁男性在机动车事故后，发生臂丛神经损伤及多处左侧神经根撕脱（C6、C7和C8），导致左臂完全瘫痪。身体右侧也出现痛觉和温度觉丧失。他接受了重建手术，但功能未得到改善。6至7年后，他的病情恶化。磁共振成像显示C7水平左侧脊髓疝。他接受了C6 - C7椎板切除术，术中发现C6 - C7处有假性脑脊膜膨出，C7神经根部位伴有局灶性脊髓疝。按照巴茨多夫所描述的技术，将脊髓疝在硬膜内复位，脑脊膜膨出的硬膜缺损用包裹在脊髓周围（脊髓与硬膜之间）的神经补片覆盖。术后，神经症状有所改善。
如果出现进一步的神经功能缺损，应采用巴茨多夫所描述的技术对脊髓疝进行手术修复。
