Ogbu Ikenna, Eltoukhy Mohamed, Tzerakis Nikolaos
Department of Neurosurgery, Royal Stoke University Hospital, University Hospitals of North Midlands (UHNM), Staffordshire, West Midlands, United Kingdom.
J Neurosurg Case Lessons. 2021 Aug 23;2(8):CASE21347. doi: 10.3171/CASE21347.
The case report detailed an unusual presentation of an iatrogenic dorsal cord herniation at the level of the thoracic cord after insertion of an epidural catheter 8 months before presentation to the neurosurgical clinic.
Only 13 cases of iatrogenic dorsal cord herniation, most of which occurred after spinal surgery, have been described in the literature. This was the first case of a spinal cord hernia described after the insertion of an epidural catheter. In this case study, the authors described a 38-year-old man who presented with progressive lower limb weakness, sensory deficits, perianal numbness, and urinary/fecal incontinence. He was diagnosed with a spinal cord hernia that reherniated after an initial sandwich duroplasty repair. Definitive repair was made after his re-presentation using an expansile duroplasty.
In patients with previous spinal instrumentation who present with neurological symptoms, spinal cord herniation should be considered a likely differential despite its rarity. In this case, a simple duroplasty was insufficient to provide full resolution of symptoms and was associated with recurrence. Perhaps a combination of graft and expansile duroplasty may be used for repair, especially when associated with a tethered cord and in the presence of significant adhesions.
该病例报告详细描述了一例医源性脊髓背侧疝的罕见表现，发生在胸段脊髓水平，在神经外科门诊就诊前8个月插入硬膜外导管后。
文献中仅描述了13例医源性脊髓背侧疝，其中大多数发生在脊柱手术后。这是第一例在插入硬膜外导管后描述的脊髓疝病例。在本病例研究中，作者描述了一名38岁男性，表现为进行性下肢无力、感觉障碍、肛周麻木以及尿便失禁。他被诊断为脊髓疝，在最初的三明治式硬脊膜成形术修复后复发。在他再次就诊后，采用扩张性硬脊膜成形术进行了确定性修复。
对于既往有脊柱内固定且出现神经症状的患者，尽管脊髓疝罕见，但应考虑其为可能的鉴别诊断。在本病例中，单纯的硬脊膜成形术不足以完全缓解症状且与复发相关。或许移植与扩张性硬脊膜成形术联合使用可用于修复，尤其是在伴有脊髓栓系和存在明显粘连的情况下。
