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Background: Several case reports about spinal cord compression due to hyperostosis at the craniocervical junction are available. However, compression at C1-C2 solely due to ossification of the posterior longitudinal ligament (OPLL) is rare. Case Description: A 50-year-old Asian male, with a history of lumbar spinal canal stenosis, presented with a progressive quadriparesis within 3 months. Imaging showed central OPLL at the C1-C2 level contributing to severe spinal cord compression. The patient improved neurologically after a C1-C2 laminectomy. Conclusion: A patient presented with a progressive Brown-Séquard syndrome due to OPLL at the craniocervical junction (C1-C2 level) and improved following a decompressive laminectomy.

Fibrocartilaginous embolism (FCE) is a rare and probably under diagnosed cause of spinal cord infarction presumably due to acute embolization of nucleus pulposus fragments into the spinal circulation. Concomitant cerebral involvement is much rarer and often asymptomatic. Although the definitive diagnosis is histologic, certain criteria have been proposed to support the diagnosis in living patients, such as absence of vascular risk factors, acute onset or antecedent of valsalva maneuver before the episode and the exclusion of potential differential diagnoses. A 56 years-old patient, without any medical history was referred for sudden back pain while carrying heavy load at work. Clinical examination showed a Brown-Sequard syndrome. Brain and spine MRI disclosed spinal cord infarction at the C4-C5 level associated with brain infarctions involving exclusively the vertebrobasilar circulation. The exhaustive etiological assessment was normal. In our case, the acute symptoms onset, the clinical and imaging data and lack of evidence for other plausible diagnoses in the setting of a valsalva-like maneuver are highly suggestive of FCE diagnosis.

Brown-Sequard Syndrome is a neurologic disorder caused by partial spinal cord injury and disruption of the corticospinal tract, dorsal columns, and spinothalamic tract. We present a 32-year-old male with partial T11-12 cord transection due to a penetrating knife injury. In addition to the classical neurological symptoms of Brown-Sequard Syndrome, he also exhibited ipsilateral peripheral vasodilatation below the level of injury. This finding is attributed to the disruption of the intermediolateral columns of the spinal cord and impaired sympathetic tone on the peripheral vasculature. Awareness of this finding can raise the radiologist's suspicion for spinal cord injury in the setting of trauma and peripheral vasodilation.

Late-onset Brown-Sequard syndrome (BSS) is a rare condition resulting from a spinal cord injury that develops weeks to years after a blunt trauma. Acute-onset BSS after a blunt injury has been rarely reported. Here, we report on a case of BSS, in a 58-year-old man, that developed immediately after a motor vehicle accident. Upon admission, loss of right thoracic motion, complete right paresis, and loss of pain and temperature sensations below the C3 level on the left side were observed. Magnetic resonance imaging showed hyperintensities within the cervical spinal cord at the C2-C3 level, confirming the diagnosis of BSS. Thoracic motion rapidly recovered, but other neurological sequelae persisted. BSS related to cervical cord injury should be suspected when patients develop hemiparesis and contralateral sensory loss immediately after a blunt trauma. Likewise, clinicians should be aware that unilateral loss of thoracic motion could be an important sign of BSS.

Background Idiopathic spinal cord herniation (ISCH) is a treatable spinal disease. It is rare and often misdiagnosed, causing a delay in management. The etiology is multifactorial, with one of the causes being duplication of the ventral dura. The spinal cord herniates within this defect and becomes strangulated, causing neurological deficits. We report the duplication of a ventral spinal cord as an important cause of ISCH in our review. Case Description We present 2 cases of ISCH with duplication of the dura, including their relevant clinical and imaging features. The patients underwent surgical reduction of the herniated spinal cord with enlargement of the defect and placement of a dural substitute ventral to the cord. We have also reported the outcomes of the 2 patients, with an emphasis on the factors predictive of poor outcomes (i.e., long-standing symptoms, a delay in intervention, poor neurological status at presentation, and a thinned out atrophic spinal cord found during surgery). We also reviewed the available data for duplication of the dura with ISCH. Conclusions Very few asymptomatic patients can be treated conservatively. The surgical outcomes have been favorable for symptomatic patients. Proper exposure, gentle manipulation while reducing the herniated spinal cord, enlargement of the defect, and the use of intraoperative monitoring will help limit the postoperative deficits. Duplication of the ventral dura is an important cause of ISCH. It prevents the formation of an anterior pseudomeningocele after surgery. Owing to the rarity of the disease and the lack of follow-up data with recurrence rates, it has not been possible to form clear guidelines for management.

Context: Idiopathic spinal cord herniation (ISCH) remains an obscure, under recognised but potentially treatable entity among the etiologies of compressive myelopathy. Findings: Here, we present a retrospective case series of eight patients of ISCH with their clinical features, imaging findings and long-term follow up data along with a relevant review of the literature. Mean age at presentation was 36 years with the duration of symptoms ranging from two months to more than thirty years. Contrary to existing data, only two patients in our series had the classical presentation of Brown-Sequard syndrome (n = 2). The clinical spectrum of the presentation was broad with pure spastic quadriparesis (n = 3), girdle sensation (n = 1) and radiculopathy (n = 1), the latter presentation has been unreported for ISCH. The typical radiological picture was seen in all patients. All except one patient was managed conservatively. In the one patient who underwent bilateral dentate ligament excision, there was mild functional improvement on long-term follow-up despite a definite worsening of the radiological picture. Five of the patients had a long-term follow-up with no clinically or functionally significant worsening. Clinical relevance: The current study highlights the wide clinical spectrum and relatively stable natural course of ISCH and reports on hitherto undescribed presentation as radiculopathy.

BACKGROUND: Anterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive myelopathy. Early surgery is essential, but there is no agreement about the best surgical approach. OBJECTIVE: To identify factors that determine surgical results, and to find evidence for the most favorable technique to correct ATSCH. METHODS: To find relevant literature, computerized databases of PubMed, EMBASE, and ISI Web of Science were searched. The current study comprised case-reports published between 1974 and 2018, and the data-set was completed with 12 cases treated in our own institute. Patient characteristics were analyzed following the principles of an individual participant data (IPD) meta-analysis. RESULTS: Brown-Séquard-like neurological deficit prior to surgery was associated with postoperative motor-function improvement when compared to patients with para-paresis (P=0.04). In the univariate analysis, widening of the dura defect (WDD) was more prevalent among improved patients, whereas anterior dura patch (ADP) and application of Intra Operative Neurophysiological Monitoring (IONM) were not. In the multivariate analysis the favorable association with WDD disappeared, which is explained by the dominant influence of a Brown-Séquard-like deficit on outcome. CONCLUSIONS: In general, postoperative results after surgery for ATSCH are favorable, with a high percentage of patients experiencing postoperative improvement. Postoperative motor function improvement is more likely to occur in patients with a Brown-Séquard-like neurological deficit. The WDD should be favored above the application of a patch as the technique of choice in surgical treatment of ATSCH.

7,8-Dihydroxyflavone (DHF) mimicks the physiological action of brain-derived neurotrophic factor (BDNF). Since local BDNF delivery to the injured spinal cord enhanced diaphragmatic respiratory function, we aimed to ascertain whether DHF might have similar beneficial effects after Brown-Sequard Syndrome in a rat model of spinal cord lateral hemisection (HX) at the 9th thoracic (T9) vertebral level.Three sets of adult female rats were included: sham+vehicle group, T9HX+vehicle group and T9HX+DHF group. On the day of surgery, HX+DHF group received DHF (5 mg/kg) while HX+vehicle group received vehicle. Neurobehavioral function, morphology of motor neurons innervating the tibialis anterior muscle and the transmission in descending motor pathways were evaluated.Adult female rats received T9 HX had paralysis and loss of proprioception on the same side as the injury and loss of pain and temperature on the opposite side. We found that, in this model of Brown-Sequard syndrome, reduced cord dendritic arbor complexity, reduced cord motoneuron numbers, enlarged cord lesion volumes, reduced motor evoked potentials, and cord astrogliosis and microgliosis were noted after T9HX. All of the above-mentioned disorders showed recovery by Day 28 after surgery. Therapy with DHF significantly accelerated the electrophysiological, histological and functional recovery in these T9HX animals.Our data provide a biological basis for DHF as a neurotherapeutic agent to improve recovery after a Brown-Sequard syndrome. Such an effect may be mediated by synaptic plasticity and glia-mediated inflammation in the spared lumbar motoneuron pools to a T9HX.

ispartof: CLINICAL LUNG CANCER vol:22 issue:4 pages:E552-E554 ispartof: location:United States status: published

Patient: Male, 33-year-old Final Diagnosis: Traumatic Brown-Séquard syndrome Symptoms: Bilateral lower limb weakness • contralateral (right) hypoesthesia from the level of the nipple below • knee and ankle jerks both were 2 on the right side and 0 on the left Medication: — Clinical Procedure: Magnetic resonance imaging (MRI) of the cervical and thoracic spine • whole-body computed tomography (CT) Specialty: Surgery Objective: Unusual clinical course Background: Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Séquard syndrome. Brown-Séquard syndrome is defined by the National Institute of Neurological Disorders and Strokes as “a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.” Case Report: A 33-year-old man was brought to the Emergency Department by Saudi Red Crescent with multiple stab wounds on the left upper thoracic and lower cervical regions. He was tachycardic, but otherwise vitally stable. His Glasgow Coma Scale score was 15. The patient presented with bilateral lower limb weakness, more on the ipsilateral (left) side, and contralateral (right) hypoesthesia from the level of the nipple below. Cervical and thoracic magnetic resonance imaging revealed ligamentous injury defect at the posterior dura and indicating a dural tear with minor cerebrospinal fluid leak. Focal hyperintense signal intensity was noted on the left side of the spinal cord, representing contusion. The patient was managed conservatively with daily physical therapy. Strength had improved substantially by the time of discharge and sensation was improving. Conclusions: Brown-Séquard syndrome is associated with good prognosis. These patients require a multidisciplinary approach because it provides the best chance of recovery to pre-injury status. These injuries may cause disastrous neurological deficits; therefore, preventive strategies should be designated to decrease the incidence of such injuries.

The annual incidence of traumatic spinal cord injury worldwide is 35 patients per million; this incidence is likely to be much higher in Latin America, where stab injuries are a common incidence. Stab injuries to the spine represent a small percentage of these cases; these are rare injuries; its management may differ compared with other penetrating injuries; these injuries are frequently complicated with neurological damage; the most common clinical manifestation is Brown–Sequard syndrome, and the most common segment involved is the thoracic region; stab injuries to the lumbar spine are rarely found in the literature. The management of patients without neurological involvement is controversial due to the risk of neurologic deterioration intraoperatively. However, failure to adequately intervene increases the risk of permanent neurological deficit, worsening functional outcomes, cerebral fluid leakage and infections. A short review of the literature and a case report are presented.

Background Brown-Séquard syndrome often occurs in spinal cord injury, and few myelitis patients present with Brown-Séquard syndrome. Case presentation A 33-year-old Han man was admitted with neck pain plus numbness in the right limbs for 2 days and weakness in the left limbs for 1 day. Examination was significant for left limbs with grade 4 muscle power, positive left Babinski sign, diminished vibration sensation in the left limbs and decreased pain below the right clavicle dermatome. The cerebrospinal fluid (CSF) cell count was 24 × 106/L, and the protein count was 185 mg/L. Cervical magnetic resonance imaging (MRI) indicated abnormal swelling signals in the medulla-cervical cord long segment and enhanced signals in the C2-3 region. In the second case, a 47-year-old Han woman was admitted with weakness in the right lower limb and numbness in the left lower limb for more than 20 days. Examination was significant for the right lower limb with grade 4 muscle power, left knee hyperreflexia, positive left Babinski sign, diminished vibration sensation in the right lower limb and decreased pain below the right T2 dermatome. Cervical MRI indicated hyperintense and enhanced signals in the C7-T2 region. In these two cases, CSF culture, oligoclonal band (OB) and aquaporin 4 (AQP4) antibody were negative. Brain MRI was normal. Their symptoms and MRI results improved after treatment with methylprednisolone. Conclusions Myelitis can present as Brown-Séquard syndrome, providing an extended reference in terms of the differential diagnosis for clinical physicians.

While idiopathic ventral thoracic spinal cord herniation was first described by Wortzman et al. 4-decades ago, the pathophysiology remains a subject of significant controversy. Due to only approximately 260 cases having been described, the majority of which were managed operatively at the time of diagnosis, little is known about the natural history of the disease which confounds decision making regarding the optimal management strategy. What we do know is that epidemiological clustering occurs in middle-aged females, and that the disease has a predilection to occur in the high thoracic spine. Despite MRI imaging being the diagnostic modality of choice, misdiagnosis as a dorsal arachnoid cyst is common, and has been reported to occur in up to 45% of cases. Regarding management the attending neurosurgeon must decide whether a conservative approach with close surveillance is to be employed, bearing in mind an unknown risk of sudden neurological deterioration, or whether surgical intervention is to be employed. Regarding the actual surgical technique employed, additional considerations are whether a ventral or dorsal approach will be used, whether the defect will simply be widened to prevent spinal cord strangulation, or whether primary dural closure, or a dural patch, will be utilized. We describe an adult male patient who presented to our unit with insidiously progressive thoracic myelopathy, presenting as a Brown Sequard syndrome, secondary to idiopathic ventral thoracic spinal cord herniation. Utilizing intra-operative neurophysiological monitoring, which we advocate as a mandatory surgical adjunct in these cases, he was taken to the operating room where a laminectomy, midline dorsal linear durotomy, division of the dentate ligaments, adhesiolysis, reduction of the herniated spinal cord, dural patch closure of the ventral defect, and duropasty of the dorsal durotomy, was performed. By utilizing this combination of techniques, we report no early worsening of the patient’s neurological deficit.

Rationale: A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. Patient concerns: A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. Diagnosis: Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3–4. Interventions: The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. Outcomes: At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. Lessons: To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.

Introduction and importance: This case report presents a rare case of vertebral artery and spinal cord injury due to air rifle pellet. Case presentation A previously healthy 19-year-old male was shot on his left neck incidentally during recreational air rifle game. He was taken to the other hospital before being referred to our hospital. Clinical findings and investigations The patient presented with total loss of motoric function on his left side of the body together with sensoric function on the contralateral side from the level of C5 and below. Signs of stroke were also spotted on the patient's face. The cervical plain radiograph and CT scan were carried out preoperatively to depict pellet fragments. Meanwhile, the CT angiography which was commenced postoperatively revealed the left vertebral artery injury. Interventions Surgery comprising of pellet fragments removal, decompression and posterior stabilization of the cervical spine was carried out to retrieve the pellet fragments, which were embedded at the posterior epidural space. Relevance and impact Our findings were consistent with the vertebral artery injury and Brown-Sequard syndrome. Hence, these clinical entities should be considered in the setting of penetrating cervical trauma.

Brown-Séquard syndrome (BSS) has many etiologies, including penetrating trauma, extramedullary tumors, and disc herniation. However, thoracic ossification of the ligamentum flavum (OLF) is an extremely rare cause of this syndrome. A 46-year-old woman with motor weakness in her right lower extremity and urinary retention was admitted to our department. Based on the results of physical examination, computed tomography, and magnetic resonance imaging, a diagnosis of BSS with OLF was considered. The patient underwent urgent conservative treatment. BSS is a rare condition characterized by hemisection or hemicompression of the spinal marrow. The herein-described case of incomplete BSS due to OLF responded to conservative treatment. However, the successful nonoperative management of this case is insufficient evidence to consider it as the standard of care. Therefore, emergency laminectomy decompression remains the standard of care for BSS.

Spinal cord injuries are frequently associated with severe clinical-neurological deficits. These are evident with specific symptoms and syndromes. Hereby, a thorough knowledge of spinal neuroanatomy is essential.Spinal anatomy, examination procedures and classical spinal syndromes are presented.Important spinal syndromes comprise the dorsal cord syndrome, spinothalamic tract syndrome, pyramidal tract syndrome, central cord syndrome, transversal and Brown-Séquard syndrome as well as combined syndromes.Clinical examination allows assessment and anatomical classification of spinal syndromes and targeted examination of the spinal cord using additional diagnostic methods.HINTERGRUND: Rückenmarkläsionen ziehen häufig schwere klinisch-neurologische Ausfälle nach sich. Diese äußern sich durch spezifische Symptome und Syndrome. Zur Einordnung ist eine gründliche Kenntnis der spinalen Neuroanatomie wichtig.Spinale Anatomie, Untersuchungsablauf und klassische spinale Syndrome werden dargestellt.Wichtige spinale Syndrome sind das Hinterstrangsyndrom, Vorderseitenstrangsyndrom, Pyramidenbahnsyndrom, zentromedulläre Syndrom, Querschnitt- und Brown-Séquard-Syndrom sowie kombinierte Syndrome.Die klinische Untersuchung erlaubt die Erfassung und anatomische Einordnung spinaler Syndrome und gezielte Untersuchung des Rückenmarks mittels Zusatzdiagnostik.

Incomplete spinal cord syndromes are clinical syndromes that show typical clinical signs in incomplete spinal cord injuries or lesions, when injuries or lesions affect specific anatomic regions of the spinal cord, with some preservation of sensory or motor function below the lesion. The clinical presentation of the incomplete spinal cord syndromes is largely determined by the involvement of the three tracts: corticospinal tract, spinothalamic tract, and posterior column of the spinal cord. There are eight types of incomplete spinal cord syndromes based on clinical presentations: central cord syndrome, Brown-Sequard syndrome (unilateral cord syndrome), anterior cord syndrome, posterior syndrome, caudal equine syndrome, conus medullaris syndrome, subacute combined degeneration myelopathy, and cruciate paralysis. Knowledge of the spinal cord anatomy and the ability to identify the typical clinical findings of common spinal cord syndromes are essential to the examination and treatment of the patient. This chapter describes the relevant anatomy of three important white matter tracts (corticospinal tract, spinothalamic tract, and posterior columns), understanding of which is crucial in diagnosing the type of incomplete spinal cord syndrome and clinical features of incomplete spinal cord syndromes.

Objective This study aims to describe the clinical characteristics of patients with sulcal artery syndrome, and between those with vertebral artery dissection against those without. Methods We report three cases of sulcal artery syndrome without vertebral artery dissection, performed a systematic review and retrospective analysis of the characteristics of patients with sulcal artery syndrome in available literature, and compared the clinical features of those with vertebral artery dissection against those without. Results We report 3 patients with sulcal artery syndrome, and analysed them with 17 other cases identified in literature between January 1990 till April 2020. The mean age was 47 years (range 10–80), with twice as many males as females. Pain at onset was a prominent feature (17/18, 94.4%). Preceding trauma occurred in less than half (7/18, 38.9%). Most had cervical cord infarctions (18/20, 90%), often over the high cervical cord (16/18, 88.9%). Good functional recovery (mRS 0–2) was observed in 86.7% (13/15). While vertebral artery dissection was the leading aetiology (11/20, 55.5%), about half of the cases were due to other causes. Cervical cord involvement was significantly associated with vertebral artery dissection (p = 0.026). Conclusion Sulcal artery syndrome should be suspected in patients with acute hemicord syndrome, especially in males with cervical cord involvement or pain at onset. High cervical cord involvement was strongly suggestive of underlying vertebral artery dissection. Additionally, DWI sequences are useful when evaluating acute myelopathies, and its inclusion in conventional MRI sequences is supported in prevailing literature.

Brown-Séquard syndrome (BSS) is a rare neurological condition caused by a hemi-lesion of the spinal cord and was first described in the 1800s. BSS is characterized by an ipsilateral absence of motor control and discriminatory/proprioceptive/vibratory sensation at and below the spinal level involved, associated with loss of contralateral temperature and pain sensation a couple of vertebral segments below the lesion. BSS is commonly associated with trauma, but can also be iatrogenic. The authors report a case of a patient who presented with neoplastic dorsal spinal cord compression and developed a BSS after surgical decompression and review of the literature of postoperative BSS cases.

Brown-Séquard syndrome (BSS) presents as an ipsilateral loss of motor function, proprioception and vibratory sensation accompanied by contralateral pain and temperature loss two to three levels below the level of the injury. It is one of the syndromes associated with incomplete transection of the spinal cord. Classic BSS is rare as most patients present with mixed neurological deficits related to damage of the spinal cord and surrounding structures. BSS remains prevalent in areas with high trauma burden, where assaults with sharp weapons are common. We present the case of a man aged 38 years who sustained a stab injury to the left back. BSS was diagnosed. He underwent removal of the weapon in the operating room and had an uneventful recovery to near baseline functional level after a course of rehabilitation. Despite being a rare aetiology, BSS continues to be an excellent reminder to trauma providers of the anatomy and physiology of neuroanatomical tracts.

Patient: Male, 25-year-old Final Diagnosis: Acute spontaneous spinal subdural hematoma Symptoms: Weakness Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • Neurology • Neurosurgery • Radiology Objective: Rare disease Background: Spontaneous spinal subdural hematoma is a rare condition that can lead to devastating neurologic deficits, usually caused by coagulation abnormalities, trauma, underlying neoplasm, or arteriovenous malformation. The patient presents with local and/or radicular pain, followed by loss of sensory, motor, bladder, and bowel function. Case Report: A 25-year-old patient presented with left-sided weakness preceded by nontraumatic upper back pain. He denied any past medical illness and being on any regular medications. He had decreased strength in the left lower limb, left upper limb, and right lower limb, with intact strength in the right upper limb. The patient exhibited decreased sensation of pain and touch on the right side of the lower limb, bilateral loss of proprioception, and intact reflexes and anal tone. He had weakness on the left side of the body and contralateral decreased sensation of pain and touch on the right side. These symptoms were suggestive of Brown-Séquard syndrome, while the bilateral loss of proprioception suggested posterior cord syndrome. Magnetic resonance imaging showed an acute spinal subdural canal hematoma producing cord compression. The patient had an urgent laminectomy and hematoma evacuation. Afterward, his neurological function improved. Conclusions: Spontaneous spinal subdural hematoma can occur without any known pathology or remarkable trauma. It can compress the spinal cord and produce cerebral stroke-like symptoms. Hence, spinal hematoma should be ruled out in any patient presenting with a neurological deficit.

Thoracic disc herniation is a rare and severe condition, whose treatment may have complications including dural tears. Although benign in most cases, dural tears may induce iatrogenic transdural herniation of the spinal cord. The video demonstrates the diagnosis and surgical treatment of iatrogenic transdural herniation of the spinal cord. Here, we report a case of spinal cord herniation after thorascopic treatment of a thoracic disc herniation (DH). A 28-yr-old male presented with several years of left lower extremity weakness and was found to have a T6-7 DH. He underwent DH resection through video assisted mini-thoracotomy at another institution. In the immediate postoperative period, he developed a Brown-Sequard syndrome with left leg weakness. The surgeon decided not to reoperate and the patient improved with rehabilitation, allowing him to walk again. At 6 mo postop, he experienced sudden neurologic worsening but did not present to our clinic until 6 mo later. At this time, he had near complete paraplegia with bilateral lower extremity spasticity and central neuropathic pain. MRI showed a pseudo-meningocele and features suggesting a lateral spinal cord herniation. After a multidisciplinary meeting, we elected to perform a posterolateral approach with costo-arthro-pediculectomy and durotomy to repair the SC herniation. Immediately postop, the patient had a slight improvement in right lower extremity function, with decreased pain and spasticity. This case shows a transdural SC herniation, a rare complication after resection of DH. It is possible that an unreported or unrecognized dural tear at the time of the initial surgery, combined with the negative pressure of the thoracic cavity, put the patient at risk for this particular complication. The authors state that the patient gave his informed consent.

Idiopathic spinal cord herniation is a rare cause of progressive myelopathy that can result in severe disability. In the following report, an illustrative case and associated video in the surgical management of ventral thoracic spinal cord herniation is presented and discussed. Spinal cord herniation is most commonly observed in the thoracic spine and is characterized by ventral displacement of the spinal cord through a defect in the dura. Over time ventral herniation of the spinal cord can compromise its vascular perfusion, resulting in further ischemic injury. The etiology is unclear, but suspected to be either acquired or congenital. Multiple surgical techniques have been reported with the goal of detethering the cord and taking adjunctive measures in reducing the risk for re-herniation. Surgical management of thoracic spinal cord herniation carries great risks, although neurological outcomes are generally favorable with improvements reported in the majority of cases.