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Symptomatic Thoracic Spinal Cord Herniation: Case Series and Technical Report

Hawasli, Ammar H. MD, PhD; Ray, Wilson Z. MD; Wright, Neill M. MD

doi: 10.1227/NEU.0000000000000437
Technical Case Report

BACKGROUND AND IMPORTANCE: Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes.

CLINICAL PRESENTATION: In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms.

CONCLUSION: Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

ABBREVIATIONS: ISCH, idiopathic spinal cord herniation

MEP, motor evoked potentials

SSEP, somatosensory evoked potentials

Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri

Correspondence: Ammar H. Hawasli, MD, PhD, Washington University School of Medicine, Department of Neurological Surgery, 660 S. Euclid Avenue, Campus Box 8057, St. Louis, MO 63110. E-mail:

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Received April 03, 2014

Accepted May 09, 2014

© 2014 by Lippincott Williams & Wilkins, Inc.
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