Surgery for idiopathic spinal cord herniation in 11 cases: a retrospective analysis

Abstract

Objective To investigate the clinical presentation, diagnosis, operative strategy and prognosis of idiopathic spinal cord herniation (ISCH). Methods and Results Clinical data of 11 ISCH cases with definite spinal cord dysfunction enrolled in Hainan Hospital and the First Medical Center of PLA General Hospital from August 2015 to December 2019 were retrospectively analyzed. The main clinical manifestations were hypesthesia of pain and temperature, while one case had lumbocrural pain and dysuria. Myasthenia or hypomyotonia was seen in 7 cases and hypermyotonia in 4 cases. One case occurred in the cervical spine, 9 cases occurred in the thoracic spine, and one case occurred in the lumbar spine. The mean Japan Orthopedic Association Scores (JOA) was 6.91. MRI demonstrated that the defect was mostly situated in the level of T4-7 vertebral bodies. Amyelotrophy and T2 hyperintense signal at the corresponding level could be detected. All patients were treated with correction of herniated spinal cord and dural defect repair, and the success rate of surgery was 100%. The postoperative clinical symptoms were improved and the postoperative recovery was well. There were no cerebrospinal fluid leakage and intracranial infection. The mean postoperative JOA score was 11.55, which was significantly improved, and the average rate of improvement was 76.44%. The average follow⁃up period for 11 patients without recurrence was 32 months. The preoperative clinical symptoms disappeared in 5 cases, improved significantly in 3 cases, and alleviate in 3 cases. Conclusions The difficulties of the treatment of ISCH are the preoperative diagnosis and the choice of the best surgical procedure. Early definite diagnosis and surgical treatment are helpful for clinical prognosis of patients.

Keywords

• hernia
• spinal cord
• thoracic vertebrae
• neurosurgical procedures