Watters M R, Stears J C, Osborn A G, Turner G E, Burton B S, Lillehei K, Yuh W T
Division of Neurology, University of Hawaii School of Medicine, USA.
AJNR Am J Neuroradiol. 1998 Aug;19(7):1337-44.
Transdural herniation of the spinal cord is a rarely reported clinical entity, and many of the existing reports were published before the advent of MR imaging. We describe five current cases and compare them with findings in 25 cases reported in the literature to delineate the clinical and imaging spectra of transdural spinal cord herniation.
MR imaging, CT myelography, and conventional myelography were performed in five patients with transdural herniation of the spinal cord. These studies, along with clinical findings, are described. Intraoperative photographs are included for one case. The salient features of both the current and previously reported cases are summarized in tabular form.
In three cases, transdural spinal cord herniation occurred posttraumatically, in one case the cause was iatrogenic and in the others the herniation occurred spontaneously. Imaging features not previously reported include dorsally directed herniations at thoracolumbar levels (two patients), apparent (lacking surgical confirmation) syringomeyelia (one case), a vertebral body nuclear trail sign (one case), and intramedullary hyperintensities on MR images (two cases). Clinical features not previously reported include unilateral pyramidal-sensory deficits (one case) and isolated unilateral pyramidal signs (one case). Clinical findings similar to previous reports include progressive paraparesis (two cases) and progressive Brown-Séquard syndrome (one case).
Our five cases illustrate certain clinical and imaging findings not previously reported, and, together with the established features of the 25 cases in the literature, delineate the spectra of transdural spinal cord herniation.
脊髓经硬膜疝是一种报道较少的临床病症，许多现有报告发表于磁共振成像（MR成像）出现之前。我们描述了5例当前病例，并将其与文献中报道的25例病例的结果进行比较，以勾勒出脊髓经硬膜疝的临床和影像学特征。
对5例脊髓经硬膜疝患者进行了MR成像、CT脊髓造影和传统脊髓造影检查。描述了这些检查结果以及临床发现。其中1例病例还提供了术中照片。以表格形式总结了当前病例和先前报道病例的显著特征。
3例脊髓经硬膜疝为创伤后发生，1例病因是医源性的，其他病例为自发性疝出。以前未报道的影像学特征包括胸腰段水平的背侧疝出（2例患者）、疑似（未经手术证实）脊髓空洞症（1例）、椎体核迹征（1例）以及MR图像上的髓内高信号（2例）。以前未报道的临床特征包括单侧锥体感觉障碍（1例）和孤立的单侧锥体征（1例）。与先前报道相似的临床发现包括进行性双下肢轻瘫（2例）和进行性布朗 - 色夸综合征（1例）。
我们的5例病例说明了某些以前未报道的临床和影像学发现，并且与文献中25例病例已确定的特征一起，勾勒出了脊髓经硬膜疝的特征。
