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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
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A case of idiopathic spinal cord herniation with duplicated dura mater

Toshiko Sugimoto1, Yuichi Kasai, Kenji Takegami

  • 1Department of Orthopaedic Surgery, Mie University Faculty of Medicine, Tsu, Mie 514-8507, Japan.

Journal of Spinal Disorders & Techniques
|February 3, 2005
PubMed

Insights

Idiopathic spinal cord herniation with duplicated dura mater is a rare condition causing walking difficulties. Surgical release of the herniated spinal cord effectively resolves symptoms, offering an excellent postoperative outcome.

Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neurology

Background:

  • Idiopathic spinal cord herniation (ISCH) is a rare condition characterized by the protrusion of the spinal cord through a defect in the dura mater.
  • Duplicated dura mater is an uncommon congenital anomaly that can predispose to spinal cord herniation.

Observation:

  • A 48-year-old male presented with progressive gait disturbance over one year.
  • Magnetic resonance imaging (MRI) and computed tomography myelography (CTM) revealed duplicated dura mater (T1-T12) and spinal cord herniation at T4-T5.
  • Intraoperative findings confirmed an elliptical dural defect (1 cm) at T4-T5 with spinal cord herniation.

Findings:

  • Surgical intervention involved widening the dural defect (1.5 cm incision), releasing the incarcerated spinal cord.
  • The patient experienced complete resolution of gait disturbance post-surgery.
  • Review of 11 cases indicated common hernial orifice levels (T4-T6), characteristic "snowman-like" spinal cord deformation on imaging, and symptom improvement with surgical widening.

Implications:

  • This case highlights the successful surgical management of ISCH with duplicated dura mater.
  • Early diagnosis and surgical intervention can lead to favorable neurological recovery.
  • Understanding the characteristic imaging findings is crucial for accurate diagnosis and treatment planning.

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