Update: Idiopathic thoracic intravertebral spinal cord herniation

Idiopathic spinal cord herniation (ISCH) is an uncommon cause of thoracic myelopathy in which the spinal cord herniates or prolapses through an anterior or lateral defect in the dura mater.

Idiopathic herniation, which results from a dural defect of unknown origin, is distinguished from herniation with a documented traumatic cause or with postoperative origin. Since the first report of idiopathic spinal cord herniation was published by Wortzman et al in 1974 1).

92 cases have been reported in the literature till 2006 2).

It is a frequently misdiagnosed condition. It preferentially affects women and causes progressive thoracic myelopathy that presents as a Brown Séquard syndrome or as spastic paraparesis. Although its etiology and pathogenesis are controversial, ISCH is characterized by the presence of an anterior dural defect that allows the incarceration of a segment of the cord. Typically, a C-shaped ventral displacement and kinking of the cord are visible on sagittal MRI. Surgery aimed at stopping or reversing myelopathic symptoms is usually recommended for symptomatic patients. Surgical options include reduction of the hernia and direct suturing, or enlargement of the dural defect, with or without patching. Suturing under the cord in a very tight space can be troublesome and may lead to neurological deterioration. The authors present the case of a symptomatic ISCH in which nonpenetrating titanium microstaples were used to close the dural defect after cord reduction. The patient experienced a good outcome, and the follow-up MRI study showed adequate cord repositioning and stability of the suture. The use of microstaples, which allows for an easier and faster dural closure than conventional suturing, is a novel technical adjunct that has not been previously reported for this condition. In addition, microstaples produce minimal metallic artifact that does not hinder the quality of follow-up MR images 3).

see Sadek AR, Nader-Sepahi A. Idiopathic thoracic intravertebral spinal cord herniation. Br J Neurosurg. 2016 Dec 14:1-2. [Epub ahead of print] PubMed PMID: 27967246 from the Department of Neurosurgery, Wessex Neurological Centre , University Hospital Southampton , Southampton , UK.


1) Wortzman G, Tasker RR, Rewcastle NB, Richardson JC, Pearson FG. Spontaneous incarcerated herniation of the spinal cord into a vertebral body: a unique cause of paraplegia. Case report. J Neurosurg. 1974 Nov;41(5):631-5. PubMed PMID: 4424434.
2) Barrenechea IJ, Lesser JB, Gidekel AL, Turjanski L, Perin NI. Diagnosis and treatment of spinal cord herniation: a combined experience. J Neurosurg Spine. 2006 Oct;5(4):294-302. PubMed PMID: 17048765.
3) Delgado-López PD, Gil-Polo C, Martín-Velasco V, Martín-Alonso J, Galacho-Harriero AM, Araus-Galdós E. Spinal cord herniation repair with microstaples: case report. J Neurosurg Spine. 2016 Nov 4:1-4. [Epub ahead of print] PubMed PMID: 27813449.

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