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. 2011 Jul;16(4):347-51.
doi: 10.1007/s00776-011-0065-z. Epub 2011 May 5.

Long-term surgical outcomes of idiopathic spinal cord herniation

Masaya Nakamura  1 , Kanehiro Fujiyoshi, Osahiko Tsuji, Kota Watanabe, Takashi Tsuji, Ken Ishii, Morio Matsumoto, Yoshiaki Toyama, Kazuhiro Chiba
Affiliations

Long-term surgical outcomes of idiopathic spinal cord herniation

Masaya Nakamura et al. J Orthop Sci. 2011 Jul.

Abstract

Background: Because of the lack of long-term postoperative follow-up studies of idiopathic spinal cord herniation (ISCH), there is little information about the long-term effectiveness and complications of the dural defect enlargement in patients with ISCH. The purpose of this study is to determine the long-term effectiveness of this procedure.

Methods: Sixteen patients with ISCH were treated surgically by enlargement of the dural defect. The patient's neurological status and surgical outcome were evaluated by the JOA scores for thoracic myelopathy and the recovery rate (mean follow-up period 9.6 years). Correlations between the surgical outcomes and patients' age and duration of disease were assessed retrospectively. The patients were also divided into two groups based on the location of the dural defect: the ventro-lateral (VL) group and the ventral (V) group. The difference in the duration of disease, preoperative JOA score, and the recovery rate were compared between the two groups.

Results: There was no recurrence of ISCH after surgery. The mean recovery rate was 42.6%. There was a significant correlation between the patient's age and the recovery rate, and between the duration of disease and the recovery rate. The median recovery rate was significantly lower in the V group than in the VL group. There were no complications related to CSF leakage after surgery.

Conclusions: Long-term surgical outcomes of enlargement of the dural defect for ISCH were stable and favorable without recurrences or any complications. This procedure should be considered for patients with ISCH before their neurological deficit worsens, especially for the patients in whom the dural defect is located at the ventral part of the dural canal.

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Figures

Fig. 1
Fig. 1
Correlation between patients’ age at the time of surgery and recovery rate (a), and between the duration of disease and recovery rate (b). There were significant correlations between patients’ age at the time of surgery and recovery rate and between the duration of disease and recovery rate
Fig. 2
Fig. 2
Comparison of the preoperative JOA scores (a) and the recovery rates (b) between the VL and V groups. While there was no significant difference in the median preoperative JOA score between the two groups, the median recovery rate of the VL group was significantly higher than that of the V group (Mann-Whitney test, p = 0.016)
Fig. 3
Fig. 3
Representative postoperative sagittal (a) and axial (b, c) T2-weighted MR images of the thoracic spinal cord, demonstrating that the spinal cord was reduced to its normal position (a, b) and that there was a CSF pooling at the ventral side of the spinal canal (a, c)
See this image and copyright information in PMC

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