Role of expansile duraplasty and neural monitoring in surgery for Anterior Thoracic Spinal Cord Herniation

Abstract

Anterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive neurological dysfunction of lower limbs where a portion of spinal cord tissue herniates through a ventral dural defect. We report a 19-year adolescent male who presented with myelopathy (Frankel D) secondary to ATSCH at D7 level and managed surgically by Anterior Patching of Dura. He worsened neurologically on the first post-operative day to Frankel B secondary to spinal cord oedema and underwent decompressive expansile duraplasty. The use of bedside neural monitoring helped in timely re-exploration and prognostication, as the patient recovered to normal neurological status in 6 months. This case report is to emphasise on considering the option of Expansile duraplasty while closing the posterior durotomy in ATSCH of more than 10 mm to prevent post-operative neurological worsening. Apart from its intra-operative applicability, electrophysiological testing could be an useful bedside tool to prognosticate neurological events in ATSCH.

Keywords

• Spinal Cord Herniation
• Expansile duraplasty
• Neural monitoring
• MEP