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Case Reports
. 2021 Aug 23;2(8):CASE21347.
doi: 10.3171/CASE21347.

Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case

Ikenna Ogbu  1 , Mohamed Eltoukhy  1 , Nikolaos Tzerakis  1
Affiliations
Case Reports

Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case

Ikenna Ogbu et al. J Neurosurg Case Lessons. .

Abstract

Background: The case report detailed an unusual presentation of an iatrogenic dorsal cord herniation at the level of the thoracic cord after insertion of an epidural catheter 8 months before presentation to the neurosurgical clinic.

Observations: Only 13 cases of iatrogenic dorsal cord herniation, most of which occurred after spinal surgery, have been described in the literature. This was the first case of a spinal cord hernia described after the insertion of an epidural catheter. In this case study, the authors described a 38-year-old man who presented with progressive lower limb weakness, sensory deficits, perianal numbness, and urinary/fecal incontinence. He was diagnosed with a spinal cord hernia that reherniated after an initial sandwich duroplasty repair. Definitive repair was made after his re-presentation using an expansile duroplasty.

Lessons: In patients with previous spinal instrumentation who present with neurological symptoms, spinal cord herniation should be considered a likely differential despite its rarity. In this case, a simple duroplasty was insufficient to provide full resolution of symptoms and was associated with recurrence. Perhaps a combination of graft and expansile duroplasty may be used for repair, especially when associated with a tethered cord and in the presence of significant adhesions.

Keywords: MRI = magnetic resonance imaging; spinal cord hernia repair; spinal cord herniation; spinal duroplasty.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
T1 MRI sequence showing the initial dorsal protrusion of the dorsal cord preoperatively.
FIG. 2.
FIG. 2.
After access into the skin, obvious incarceration of the cord by dural and arachnoid adhesions is visible, forming a ring around the herniated cord.
FIG. 3.
FIG. 3.
Cord reduced into intrathecal sac before closure using an expansile duroplasty.
FIG. 4.
FIG. 4.
A T2 MRI short T1 inversion recovery sequence showing improved herniation of the cord at clinic follow-up. The inset picture shows the plane at which the larger sagittal slice (the bigger picture) was taken.
See this image and copyright information in PMC

References

    1. Khattar NK, Donovan AM, Oxford BG, Adams SWC, Altstadt TJ. Traumatic ventral cervical spinal cord herniation: a case report. Cureus. 2019;11(2):e4070. - PMC - PubMed
    1. Francis D, Batchelor P, Gates P. Posttraumatic spinal cord herniation. J Clin Neurosci. 2006;13(5):582–586. - PubMed
    1. Papavero L, Engler N, Kothe R. Incidental durotomy in spine surgery: first aid in ten steps. Eur Spine J. 2015;24(9):2077–2084. - PubMed
    1. Richter B, Xu C, Jho DH. Technical note: inlay-onlay sandwich graft technique for repairing durotomy in spine surgery for fragile dura. J Spine Neurosurg. 2016;5:3.
    1. Zakaria R, Ellenbogen JR, Grewal IS, Buxton N. Posterior spinal cord herniation: a novel occurrence following surgery for an intramedullary cyst at the thoracolumbar junction. Eur Spine J. 2013;22(suppl 3):S399–S403. - PMC - PubMed

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