Thoracic spinal cord herniation: case report and technical note

Idiopathic spinal cord herniation and tethering through an anterior dural defect in the thoracic spine is an uncommon but increasingly recognized cause of Brown-Séquard syndrome. High-resolution magnetic resonance imaging is the method of choice to visualize anterior herniation of the spinal cord, although computed tomography myelography may still be performed. Idiopathic spinal cord herniation is a treatable cause of myelopathy. Notably, surgical treatment, consisting of reducing the herniation by closing the dural defect with the use of sutures, or enlarging the dural defect, has been recommended as the procedure of choice, but is difficult to perform in the small space in front of the spinal cord. When the dural defect is enlarged, recurrent transdural herniation may occur. We describe a new technique by wrapping a dura graft, biological glue and haemostatic around the spinal cord to prevent recurrent transdural herniation.