Axumawi Gebreyohanes1,2, Arshad Zubair3, Jonathan Lui3, Adrian Casey3, Parag Sayal3. 1. Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK. axum.gebreyohanes@nhs.net. 2. University College London (UCL) Medical School, London, UK. axum.gebreyohanes@nhs.net. 3. Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK.
Abstract
INTRODUCTION: Myelopathy arising due to dorsal herniation of the spinal cord is a rare phenomenon, particularly so in the thoracic region. Where cases of thoracic dorsal cord herniation have been reported, the aetiology has typically been non-iatrogenic. CASE PRESENTATION: We report the case of a paediatric oncology patient who presented with neurological deterioration secondary to thoracic dorsal spinal cord herniation, manifesting three months after laminectomy for biopsy of a spinal medulloblastoma lesion. We repaired the dural defect using non-penetrating titanium clips to create a secure expansile duraplasty, resulting in radiologically evident reduction of the cord herniation as well as corresponding clinical improvement. DISCUSSION: Thoracic dorsal spinal cord herniation is an extremely rare occurrence after spinal surgery. Non-penetrating titanium clips can be used to form a secure expansile duraplasty following reduction of the cord herniation. Successful repair of the dural defect re-anteriorises the cord and can confer neurological benefit.
INTRODUCTION: Myelopathy arising due to dorsal herniation of the spinal cord is a rare phenomenon, particularly so in the thoracic region. Where cases of thoracic dorsal cord herniation have been reported, the aetiology has typically been non-iatrogenic. CASE PRESENTATION: We report the case of a paediatric oncology patient who presented with neurological deterioration secondary to thoracic dorsal spinal cord herniation, manifesting three months after laminectomy for biopsy of a spinal medulloblastoma lesion. We repaired the dural defect using non-penetrating titanium clips to create a secure expansile duraplasty, resulting in radiologically evident reduction of the cord herniation as well as corresponding clinical improvement. DISCUSSION: Thoracic dorsal spinal cord herniation is an extremely rare occurrence after spinal surgery. Non-penetrating titanium clips can be used to form a secure expansile duraplasty following reduction of the cord herniation. Successful repair of the dural defect re-anteriorises the cord and can confer neurological benefit.
Authors: Tri C Le; Betsy H Grunch; Isaac O Karikari; Ankit I Mehta; Timothy R Owens; Oren N Gottfried; Carlos A Bagley Journal: Spine J Date: 2012-10-23 Impact factor: 4.166