Johns Hopkins University School of Medicine, Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA.
University of South Florida Morsani College of Medicine, Department of Neurosurgery, Tampa General Hospital, Tampa, Florida, USA.
World Neurosurg. 2020 May;137:376-378. doi: 10.1016/j.wneu.2020.02.102. Epub 2020 Feb 26.
Cervical myelomeningocele (MMC) is a very rare neural type defect that is usually discovered and managed in childhood. It is best described as a closed type of spinal dysraphism, where the posterior portion of the cervical thecal sac forms a pouch that bulges out through a narrow posterior spina bifida and contains spinal neural tissue with or without cerebrospinal fluid.
We report a 47-year-old male patient who presented with neck pain and decreased ability to use his fingers that had progressed over 3 years before presentation. Cervical spine magnetic resonance imaging revealed a posterior bulge between the spinous processes of C4 and C6, absence of the spinous process of C5, and presence of cerebrospinal fluid and spinal cord tissue and nerve roots within the bulging sac, suggestive of MMC. Simple untethering of the cord tissue was sufficient to halt the progression and allow for improvement in neurological deficits.
Cervical MMC is extremely rare in adults, the symptomatic progression of which is most likely because of cord tethering by fibrotic tissue formation over years. Early surgical correction and release of the tethered cord is relatively safe and prevents the evolution of neurological symptoms.
颈椎脊膜脊髓膨出（MMC）是一种非常罕见的神经管缺陷，通常在儿童时期被发现并进行治疗。它被最好地描述为一种闭合型脊柱脊膜裂，其中颈髓的后部分形成一个囊袋，通过狭窄的后脊柱裂向外膨出，其中包含脊髓神经组织和/或脑脊液。
我们报告了一名 47 岁男性患者，他因颈痛和手指活动能力下降而就诊，这些症状在就诊前 3 年逐渐加重。颈椎磁共振成像显示 C4 和 C6 棘突之间有一个后凸，C5 棘突缺失，并且在膨出的囊内有脑脊液和脊髓组织以及神经根，提示为 MMC。简单地松解脊髓组织就足以阻止病情进展，并改善神经功能缺损。
颈椎 MMC 在成人中极为罕见，其症状的进展很可能是由于多年来纤维组织形成导致的脊髓拴系。早期手术矫正和松解拴系的脊髓相对安全，并可防止神经症状的演变。
