Thoracic idiopathic spinal cord herniation in a young patient: a diagnostic and therapeutic challenge

BMJ Case Rep. 2019 May 21;12(5):e227847. doi: 10.1136/bcr-2018-227847.

Abstract

Idiopathic Spinal Cord Herniation (ISCH) is considered to be a rare cause of Thoracic Myelopathy. It is secondary to the gliding of the Spinal Cord through an anterior dural defect, without a completely defined cause. We present a case of ISCH which, even though was in its usual location, developed in a woman at a younger age than expected. The patient was 20 years old when diagnosed with Brown-Séquard Syndrome. MRI showed herniation at T4-T5 level, which was corrected using a posterior approach to expose the dural defect, reduce the herniation and place a heterologous graft. Postoperatively, neurological function improved, and adequate reduction was seen on imaging. Given the reports of recurrence and deterioration that have been seen after 18 months, follow-up was prolonged for a total of 2 years. We consider postoperative MRI performance important to establish the degree of reduction and alignment of the Spinal Cord.

Keywords: neuroimaging; neurosurgery; spinal cord.

Publication types

  • Case Reports

MeSH terms

  • Brown-Sequard Syndrome / diagnosis*
  • Female
  • Hernia / diagnostic imaging*
  • Herniorrhaphy / methods
  • Humans
  • Laminectomy / methods
  • Magnetic Resonance Imaging
  • Rare Diseases
  • Spinal Cord / pathology*
  • Spinal Cord Diseases / diagnosis*
  • Spinal Cord Diseases / physiopathology
  • Spine / diagnostic imaging
  • Spine / surgery
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / surgery
  • Treatment Outcome
  • Young Adult