Hunziker S, Örgel A, Tatagiba M, Adib S D
Department of Neurosurgery, University of Tuebingen, Tübingen, Germany.
Department of Diagnostic and Interventional Neuroradiology, University of Tuebingen, Tübingen, Germany.
Front Surg. 2023 Aug 8;10:1238448. doi: 10.3389/fsurg.2023.1238448. eCollection 2023.
The pathophysiology of idiopathic spinal cord herniation remains unknown. However, several different factors have been postulated, such as congenital causes (ventral dura mater duplication, preexisting pseudomeningocele, or other congenital dural defects), inflammation, remote spinal trauma, or thoracic disc herniation. Herein, the diagnosis and surgical treatment of a patient with spinal cord herniation caused by an intraspinal bone spur is presented along with a relevant literature review.
A 56-year-old male patient presented with a non-traumatic Brown-Sequard syndrome persisting for over 1 year. A magnetic resonance imaging of the spinal axis revealed a ventral spinal cord displacement in the level of T 6/7. A supplementary thin-sliced computed tomography of the spine revealed a bone spur at the same level. For neurosurgical intervention, T 6 and T 7 laminectomy was performed. The cranial and caudal end of the right paramedian ventral dural defect was visualized and enlarged. Following extradural spinal cord mobilization by denticulate ligament transection, the spinal cord was finally released. The spinal cord was rotated and the ventral closure of the dural defect was performed by continuous suture. The patient recovered from surgery without additional deficits. The patient's postoperative gait, sensory, and motor function deficits improved, and further neurological deterioration was prevented.
Since the first description of spinal cord herniation by Wortzman et al. in 1974, approximately 260 cases have been reported in the literature. In addition to other causes, intraspinal bone spur is a possible cause of spinal cord herniation.
特发性脊髓疝的病理生理学仍不清楚。然而，已经提出了几种不同的因素，如先天性原因（腹侧硬脑膜重复、既往存在的假性脊膜膨出或其他先天性硬脑膜缺损）、炎症、远处脊柱创伤或胸椎间盘突出。本文介绍了一名因椎管内骨赘导致脊髓疝患者的诊断和手术治疗，并进行了相关文献综述。
一名56岁男性患者出现非创伤性布朗-塞卡尔综合征，持续超过1年。脊柱磁共振成像显示T 6/7水平腹侧脊髓移位。脊柱补充薄层计算机断层扫描显示同一水平有骨赘。为进行神经外科干预，实施了T 6和T 7椎板切除术。可见并扩大了右侧旁正中腹侧硬脑膜缺损的头端和尾端。通过切断齿状韧带进行硬膜外脊髓松解后，脊髓最终得以松解。旋转脊髓，通过连续缝合对硬脑膜缺损进行腹侧闭合。患者术后恢复，未出现额外的神经功能缺损。患者术后的步态、感觉和运动功能缺损得到改善，防止了进一步的神经功能恶化。
自1974年Wortzman等人首次描述脊髓疝以来，文献中已报道约260例病例。除其他原因外，椎管内骨赘是脊髓疝的一个可能原因。
