Sioutos P, Arbit E, Tsairis P, Gargan R
Neurosurgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Spine (Phila Pa 1976). 1996 Jul 15;21(14):1710-3. doi: 10.1097/00007632-199607150-00019.
This is a case report.
To focus attention on spontaneous spinal cord herniation as a rare cause of myelopathy that can be diagnosed preoperatively and can be corrected surgically.
A 34-year-old woman presented with spastic paraparesis. Magnetic resonance imaging scan of the thoracic spine revealed anterior displacement and tethering of the cord at T6-T7 and a dorsal intradural arachnoid cyst. Excision of the cyst was performed without improvement in symptomatology. During reoperation the thoracic spinal cord hernia was discovered and was reduced intradurally.
The authors describe the clinical, radiographic, and surgical findings of this patient and review the findings from other reported cases. They discuss the proposed theories for the pathophysiology of the cord herniation and the surgical management.
The patient had idiopathic thoracic spinal cord herniation as there was no history of previous spine surgery or injury. The authors believe that the cord herniated through a congenital dural defect, which resulted in the development of a pseudoarachnoid cyst dorsally to the hernia. The patient improved after intradural reduction of the hernia and closure of the dural defect.
Idiopathic spinal cord herniation should be recognized as a cause of progressive myelopathy that can be managed successfully with microsurgical techniques.
这是一篇病例报告。
关注自发性脊髓疝作为一种罕见的脊髓病病因，其可在术前诊断并可通过手术矫正。
一名34岁女性出现痉挛性截瘫。胸椎磁共振成像扫描显示脊髓在T6 - T7水平向前移位并受牵拉，同时存在硬膜内背侧蛛网膜囊肿。囊肿切除术后症状无改善。再次手术时发现胸段脊髓疝并在硬膜内将其还纳。
作者描述了该患者的临床、影像学及手术发现，并回顾了其他报道病例的发现。他们讨论了脊髓疝病理生理学的相关理论及手术治疗方法。
该患者患有特发性胸段脊髓疝，因为既往无脊柱手术或损伤史。作者认为脊髓通过先天性硬膜缺损疝出，导致在疝上方形成假性蛛网膜囊肿。硬膜内将疝还纳并封闭硬膜缺损后患者病情改善。
特发性脊髓疝应被视为进行性脊髓病的一个病因，可通过显微外科技术成功治疗。
