Ventral spinal cord herniation

What is it?

Ventral spinal cord herniation is a condition characterized by protrusion and herniation of the spinal cord which can cause damage to the nerve tracts. Spinal cord protrudes outward into the epidural space through a defect in the hard meninges (dura), exclusively in the anterior thoracic spine, facing the abdomen. Due to the constriction of the spinal cord in the dura, neurological damage occurs, varying from mild to very severe, when surgical relief of the entrapped spinal cord is the only therapeutic option.

The causes that lead to this condition are not fully known, but the most likely are:

  • a structural weakness of the dura
  • kyphosis
  • trauma
  • a herniated disc.

Symptoms

Characteristic symptoms usually develop insidiously, including sensory disorders, muscle weakness and bladder and fecal incontinence, weakness of voluntary motor function and delicate sensibility, insensations to touch, temperature, and pain.

 

Diagnosis

Spinal cord herniation is best visualized using magnetic resonance imaging (MRI). Arachnoid cyst can easily be mistaken for spinal cord herniation – definitive diagnosis is only possible during surgery.

Computed tomography (CT) with contrast medium in the nerve fluid space (CT myelography) can provide additional information about the condition.

Treatment

Treatment

Whether and when surgical treatment is required is determined by severity of the neurological symptoms. In most cases, serious neurological disorders are present, and surgery is necessary to prevent further progression of the disease. Neurological disorders that are already present often can’t be reversed by surgery, so it is very important to prevent further damage and to maintain the current neurological status.

Reposition the spinal cord to its normal position and closure of the defect in the dura is challenging surgery because prolapsed spinal cord trapped in the dura defect may be fused to the surrounding tissue. Additional damage can occur when the adhesions are released. Almost in all cases of spinal cord herniation, a complete removal of the vertebral arch (laminectomy) via a dorsal approach is necessary. An alternative is a lateral approach via the thoracic cage. The stability of the thoracic spine is not affected by either approach, therefore stabilization of the spine with screws usually is not necessary. Finally, the defective area in the nerve membranes is closed with dura substitutes and sutures (duraplasty).

 

Recovery

After only a few days, the patient can be discharged with no restrictions in the mobility or stability of the spine.

Before the appointment with Dr. Krajnović, it would be good to:

  • Make a list of the previous medical illnesses.
  • Make a list of medical problems that arise in the family.
  • Make a list of the symptoms.
  • Make a list of questions to ask the doctor.