Spinal cord herniation following cervical laminoplasty: illustrative case

Postoperative spinal cord herniation (SCH) is an exceptionally rare but serious delayed complication of cervical decompressive surgery, resulting from a dorsal dural defect associated with pseudomeningocele formation. The authors report the case of a 73-year-old man who developed quadriparesis 6 years after C3-6 laminoplasty for ossification of the posterior longitudinal ligament.

MRI demonstrated dorsal herniation of the spinal cord through a dural defect into a cystic lesion consistent with a postoperative pseudomeningocele at C4. Reexploration via a posterior midline approach revealed a 3-mm dorsal dural defect with an entrapped spinal cord. Following adhesion dissection and reduction of the herniated cord, duraplasty using a collagen-based dural substitute was performed. Postoperative imaging confirmed successful cord repositioning. Neurological symptoms improved, and no recurrence was observed during the 7-month follow-up period.

Including this case, only 17 cases of postoperative SCH have been reported, most of which occurred after posterior cervical surgery with intraoperative dural injury or incomplete repair. The proposed mechanism involves gradual cord herniation and tethering through a postoperative dural defect under the influence of CSF pulsation and cervical motion. Early recognition and meticulous watertight dural reconstruction are crucial for favorable neurological recovery and the prevention of recurrence. https://thejns.org/doi/10.3171/CASE26136.