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Anterior Cord Herniation-Surgical Video.

Henrietta Nittby Redebrandt1, Sven Köhler2, Niklas Marklund1

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Anterior cord herniation, a rare spinal condition, can cause progressive leg dysfunction. Surgical repair led to significant recovery, demonstrating the potential benefits of intervention despite intraoperative neurophysiological monitoring changes.

Keywords:
Anterior cord herniationNeurophysiology

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neurology

Background:

  • Anterior cord herniation involves ventral spinal cord displacement through dural defects.
  • This rare condition can lead to slowly deteriorating neurological symptoms, often presenting as Brown-Séquard-like syndrome.
  • Surgical intervention is considered for progressive neurological deficits, despite potential risks.

Purpose of the Study:

  • To present a case of anterior cord herniation causing progressive lower extremity dysfunction.
  • To discuss the surgical management and intraoperative neurophysiological monitoring in this rare condition.
  • To highlight the patient's recovery following surgical repair.

Main Methods:

  • Case report of a patient with progressive gait disturbance due to anterior cord herniation.
  • Surgical exploration involving laminectomy, dural opening, and repair with dural substitute.
  • Intraoperative neurophysiological monitoring including D-wave, sensory evoked potentials (SEP), and motor evoked potentials (MEP).

Main Results:

  • The patient experienced rapid deterioration of motor function and gait disturbance.
  • Intraoperative motor evoked potentials (MEP) were lost at the end of the procedure, a predictor of permanent deficits.
  • Despite MEP loss, the patient achieved an uneventful recovery, walking with crutches three months post-operatively.

Conclusions:

  • Surgical exploration and repair can be effective for anterior cord herniation causing progressive neurological deficits.
  • Intraoperative neurophysiological monitoring is crucial but its findings do not always predict the final outcome.
  • This case underscores the possibility of significant recovery even after complete loss of MEP during surgery.