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Transdural spinal cord herniation: imaging and clinical spectra
M R Watters1, J C Stears, A G Osborn
1Division of Neurology, University of Hawaii School of Medicine, USA.
Purpose:
Transdural herniation of the spinal cord is a rarely reported clinical entity, and many of the existing reports were published before the advent of MR imaging. We describe five current cases and compare them with findings in 25 cases reported in the literature to delineate the clinical and imaging spectra of transdural spinal cord herniation.
Methods:
MR imaging, CT myelography, and conventional myelography were performed in five patients with transdural herniation of the spinal cord. These studies, along with clinical findings, are described. Intraoperative photographs are included for one case. The salient features of both the current and previously reported cases are summarized in tabular form.
Results:
In three cases, transdural spinal cord herniation occurred posttraumatically, in one case the cause was iatrogenic and in the others the herniation occurred spontaneously. Imaging features not previously reported include dorsally directed herniations at thoracolumbar levels (two patients), apparent (lacking surgical confirmation) syringomeyelia (one case), a vertebral body nuclear trail sign (one case), and intramedullary hyperintensities on MR images (two cases). Clinical features not previously reported include unilateral pyramidal-sensory deficits (one case) and isolated unilateral pyramidal signs (one case). Clinical findings similar to previous reports include progressive paraparesis (two cases) and progressive Brown-Séquard syndrome (one case).
Conclusion:
Our five cases illustrate certain clinical and imaging findings not previously reported, and, together with the established features of the 25 cases in the literature, delineate the spectra of transdural spinal cord herniation.
Insights
Transdural spinal cord herniation is rare, often occurring post-traumatically or spontaneously. This study details new imaging and clinical findings in five cases, expanding understanding of this condition.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Transdural spinal cord herniation is an uncommon condition, with limited data available, particularly from before the widespread use of advanced imaging techniques like MRI.
- Understanding the full spectrum of clinical presentations and imaging characteristics is crucial for accurate diagnosis and management.
Observation:
- This study presents five new cases of transdural spinal cord herniation, analyzed alongside 25 previously reported cases.
- Imaging modalities included MRI, CT myelography, and conventional myelography.
- Clinical data and intraoperative findings were correlated with imaging results.
Findings:
- Etiologies included post-traumatic (3 cases), iatrogenic (1 case), and spontaneous (1 case) origins.
- Novel imaging findings identified were dorsally directed herniations, apparent syringomyelia, a vertebral body nuclear trail sign, and intramedullary hyperintensities on MRI.
- New clinical observations included unilateral pyramidal-sensory deficits and isolated unilateral pyramidal signs, alongside previously reported progressive paraparesis and Brown-Séquard syndrome.
Implications:
- The findings expand the known clinical and imaging spectrum of transdural spinal cord herniation.
- This comprehensive review aids in better recognizing and diagnosing this rare condition.
- Improved understanding may lead to earlier detection and more effective treatment strategies.
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