Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
World Neurosurg. 2020 May;137:1-7. doi: 10.1016/j.wneu.2020.01.129. Epub 2020 Jan 28.
Spinal cord herniation (SCH) is often described as occurring spontaneously in the thoracic spine, with few cases of cervical SCH reported as a late complication of traumatic brachial plexus avulsion. We present 2 cases of nerve root avulsion and pseudomeningocele formation, resulting in delayed cervical SCH and neurologic deterioration.
Case 1: A 37-year old man presented with progressive leg weakness 2 years after experiencing traumatic C8 and T1 root avulsions. Magnetic resonance imaging (MRI) showed previously documented C8-T1 nerve avulsions with new SCH in a T1 pseudomeningocele. A C7-T1 costotransversectomy and C4-T4 instrumented fusion were completed, allowing SCH reduction and patch graft repair of the dural defects without the need for adhesiolysis. At last follow-up, the patient's leg weakness had resolved. Case 2: A 32-year old man presented with progressive right arm numbness, weakness, and signs of myelopathy 9 years after experiencing C8 and T1 root avulsions. MRI showed previously documented root avulsions and new SCH with extensive and compressive pseudomeningocele formation. A C7 transpedicular approach with C5-T1 instrumented fusion was completed for dural repair. A large pseudomeningocele was found and drained on drilling the C7 pedicle, and adhesiolysis was required at the spinal cord avulsion site to reduce the SCH and allow patch graft repair. At last follow-up, the patient's right arm weakness was improving, although numbness persisted.
SCH is a rare cause of delayed neurologic deterioration after brachial plexus avulsion, with few case reports describing its occurrence. We present 2 cases of this complication and describe its successful surgical treatment through dural repair after instrumented fusion.
脊髓疝（SCH）常发生于胸椎，颈椎 SCH 作为创伤性臂丛神经撕脱的迟发性并发症较为少见。我们报告了 2 例神经根撕脱和假性脑膜膨出形成导致的迟发性颈椎 SCH 和神经功能恶化。
病例 1：一名 37 岁男性，在经历 C8 和 T1 神经根撕脱伤 2 年后出现进行性下肢无力。磁共振成像（MRI）显示先前记录的 C8-T1 神经撕脱，T1 假性脑膜膨出中有新的 SCH。完成了 C7-T1 肋横突切除术和 C4-T4 器械融合术，实现了 SCH 复位和硬脑膜缺损修补，无需进行粘连松解。末次随访时，患者下肢无力已缓解。病例 2：一名 32 岁男性，在经历 C8 和 T1 神经根撕脱伤 9 年后出现进行性右上肢麻木、无力和脊髓病体征。MRI 显示先前记录的神经根撕脱和新的 SCH，伴广泛且有压迫的假性脑膜膨出形成。完成了 C7 经椎弓根入路和 C5-T1 器械融合术以修复硬脑膜。在钻 C7 椎弓根时发现一个大的假性脑膜膨出并引流，需要在脊髓撕脱部位进行粘连松解以缩小 SCH，并允许进行补丁移植修复。末次随访时，患者的右上肢无力正在改善，尽管麻木仍存在。
SCH 是臂丛神经撕脱后迟发性神经功能恶化的罕见原因，仅有少数病例报告描述了其发生。我们报告了 2 例该并发症，并描述了通过器械融合后的硬脑膜修复成功治疗该并发症。
