BACKGROUND CONTEXT: Transdural spontaneous spinal cord herniation is a very rare nosological entity, which despite recent reports in the medical literature remains often misdiagnosed preoperatively. Usually it affects the thoracic segment, protrudes ventrally, presents clinically as a progressive Brown-Séquard syndrome and carries a favorable surgical outcome. PURPOSE: To describe a rare case of delayed recurrence of spontaneous spinal cord herniation despite excellent outcome for 10 years, and discussion of management and observation issues. STUDY DESIGN/ SETTING: Case report/University Hospital. METHODS: We describe the management of a patient with spontaneous spinal cord herniation that presented initially with a Brown-Séquard syndrome and has been treated successfully with surgery. After 10 years free of symptoms, the patient developed progressive paraparesis and urinary incontinence because of recurrence of the herniation at the same level. RESULTS: Despite technical challenges, during the second operation the enlarged ventral dural defect was meticulously closed and the patient's neurological condition presents 9-month postsurgery considerable improvement. To our best knowledge, recurrences of spontaneous spinal cord herniation are extremely rare. CONCLUSIONS: The reported case underlines the necessity to be aware of this rare but treatable spinal disease, notify the possibility of late recurrences and the need of long-term follow-up even if initial outcome is favorable.
BACKGROUND CONTEXT: Transdural spontaneous spinal cord herniation is a very rare nosological entity, which despite recent reports in the medical literature remains often misdiagnosed preoperatively. Usually it affects the thoracic segment, protrudes ventrally, presents clinically as a progressive Brown-Séquard syndrome and carries a favorable surgical outcome. PURPOSE: To describe a rare case of delayed recurrence of spontaneous spinal cord herniation despite excellent outcome for 10 years, and discussion of management and observation issues. STUDY DESIGN/ SETTING: Case report/University Hospital. METHODS: We describe the management of a patient with spontaneous spinal cord herniation that presented initially with a Brown-Séquard syndrome and has been treated successfully with surgery. After 10 years free of symptoms, the patient developed progressive paraparesis and urinary incontinence because of recurrence of the herniation at the same level. RESULTS: Despite technical challenges, during the second operation the enlarged ventral dural defect was meticulously closed and the patient's neurological condition presents 9-month postsurgery considerable improvement. To our best knowledge, recurrences of spontaneous spinal cord herniation are extremely rare. CONCLUSIONS: The reported case underlines the necessity to be aware of this rare but treatable spinal disease, notify the possibility of late recurrences and the need of long-term follow-up even if initial outcome is favorable.
Authors: Ronald H M A Bartels; Han Brunner; Allard Hosman; Nens van Alfen; J André Grotenhuis Journal: Front Neurol Date: 2017-09-11 Impact factor: 4.003