Dorsal cervical spinal cord herniation precipitated by kyphosis deformity correction for spinal cord tethering.

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Dorsal cervical spinal cord herniation precipitated by kyphosis deformity correction for spinal cord tethering.

World Neurosurg. 2017 Feb 18;:

Authors: Heller RS, Hwang SW, Riesenburger RI

Abstract
INTRODUCTION: Cervical spinal cord herniation (SCH) is a rare clinical entity. Reported following prior intradural surgery or surgery complicated by durotomy, patients return several months to years later with symptoms of worsening myelopathy. Herein is presented a case of a 51-year old female with SCH in the cervical spine following kyphosis deformity correction CASE DESCRIPTION: A 51-year old female presented to the Neurosurgery clinic with worsening cervical myelopathy due to cervical spinal cord tethering and adhesions from prior intradural surgery for Chiari malformation. Conservative treatment was initially recommended but ultimately unsuccessful as her neurological function continued to deteriorate. Follow-up imaging demonstrated progressive cervical kyphotic deformity with stability of the tethered spinal cord. The patient underwent cervical deformity correction to reduce tension on the spinal cord, after which her neurological symptoms stabilized and began to improve with physical therapy. Four months after surgery, she returned to clinic with recurrence of cervical myelopathy. Repeat imaging demonstrated herniation of the cervical spinal cord through a dorsal defect, and the patient was successfully treated with a wide cervical duraplasty to recreate an intact thecal sac.
DISCUSSION: The inability of the spinal cord to compensate for changes in spinal alignment in cases of tethering make it susceptible to increased pressure and tension at the point of tethering. Caution is urged when attempting deformity correction in the presence of spinal cord tethering, which may limit the capacity of the spinal cord and surrounding tissue to compensate for alterations in spinal alignment.

PMID: 28223250 [PubMed - as supplied by publisher]

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