Anterior Cord Herniation-Surgical Video

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.