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      Pathophysiology and Grading of the Ventral Displacement of Dorsal Spinal Cord Spectrum

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          Abstract

          Study Design

          A retrospective study of the ventral displacement of dorsal spinal cord (VDDSC) spectrum pathophysiology and grading.

          Purpose

          This study aimed at examining the pathophysiology of VDDSC between D3 and D7, using magnetic resonance imaging (MRI) correlation and severity grading.

          Overview of Literature

          The pathologies that lead to VDDSC were previously discussed in various articles. We attempted to group these pathological conditions under a single spectrum, and grade them according to their severity.

          Methods

          We reviewed the MRI images of the dorsal spines of 1,350 patients over a period of 4 years (February 2013–February 2017); all MRI images were analyzed by two experienced radiologists.

          Results

          Of the 1,350 patients, 28 exhibited VDDSC between D3 and D7. Additional findings included ventral transdural herniation of the spinal cord (n=10), anterior spinal cord adhesion (n=7), arachnoid web (n=6), and arachnoid cyst (n=5).

          Conclusions

          We grouped the pathologies that lead to VDDSC at the thoracic level into a single spectrum of varying severity and graded VDDSC, from mild to severe.

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          Most cited references15

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          Spontaneous incarcerated herniation of the spinal cord into a vertebral body: a unique cause of paraplegia. Case report.

          Andrea Richardson, R Tasker, N Rewcastle … (1974)
          Article 0 comments Cited 30 times – based on 0 reviews     Review now
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            Idiopathic spinal cord herniation: a new theory of pathogenesis.

            Sonia Najjar, S S Lingawi, Saleh S Baeesa (2004)
            Idiopathic spinal cord herniation is a rare entity that has been described more frequently over the past few years. Its pathophysiology remains obscure, however. We report a case of spinal cord herniation and review the literature extensively. In view of our review, we try to determine the clinical features of the condition and the diagnostic measures used, with emphasis on the role of magnetic resonance (MR) phase-contrast CSF study. The factors affecting the outcome of the condition are also studied including time and type of presentation, as well as the surgical procedure performed. The pathophysiological mechanisms behind spontaneous herniation are discussed, and a new hypothesis is proposed. Idiopathic spinal cord herniation occurs in the middle-aged adult, with a preponderance of patients being female. Brown-Séquard syndrome is the most common clinical presentation and usually progresses to spastic paraparesis. MRI typically shows a ventral kink in the thoracic cord, with MR phase-contrast imaging proving an important addition to exclude an arachnoid cyst. Better outcomes were noted in the patients treated earlier, and in those with no spasticity. Widening the dural defect seems to afford better results compared to grafting of the defect. The prognosis is favorable after correction, though a vertebral body herniation variant may be associated with worse outcome. In view of the chronology of events and imaging studies in our patient, we hypothesize that herniation occurs as an acquired phenomenon where an inflammatory process results in adherence between the spinal cord and the dura, with erosion, formation of a dural defect, and then later herniation occurring with cerebral spinal fluid (CSF) pulsations. Idiopathic herniation of the spinal cord should be recognized and treated early to reach a favorable outcome. It seems to be an acquired condition likely caused by an inflammatory event, the nature of which is to be determined.
            Article 0 comments Cited 19 times – based on 0 reviews     Review now
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              Idiopathic spinal cord herniation: Clinical review and report of three cases

              Johanne Summers, Yagnesh Balasubramani, Patrick C. H. Chan … (2013)
              Idiopathic spinal cord herniation (ISCH) is a rare condition, of unknown pathogenesis, that primarily affects the thoracic spinal cord. It is characterized by ventral displacement of the spinal cord through a dural defect. The aim of this study was to review the literature and to present a retrospective single center experience with three cases of ISCH. The literature review analyzed a total of 78 relevant publications on ISCH, which included a total of 171 patients, supplemented with 3 patients treated at our institution. Numerous case reports have demonstrated improvement in clinical outcomes after surgery; however, follow-up is predominantly short, data are incomplete, the condition is frequently misdiagnosed, and it is difficult to predict which patients will benefit from surgery. We identified 159 cases treated with surgical management. The mean symptom duration was 54 months, and the mean follow-up 33 months. The result at follow-up was improved neurological outcome in 74%, unchanged result in 18%, and worse outcome in 8%. There were 15 cases of conservative management, with mean symptom duration 52 months and mean follow-up 33 months. The neurological outcome was unchanged in 100%. ISCH is a rare condition causing progressive thoracic myelopathy, and the natural history is unknown. There is a lack of evidence-based treatment strategies, and the majority of cases are treated with surgical management at diagnosis. Management of ISCH needs to be individualized for each patient, and clinicians should be encouraged to report new cases, standardize case reports, and ensure long-term follow-up.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Asian Spine J
                Journal ID (iso-abbrev): Asian Spine J
                Journal ID (publisher-id): ASJ
                Title: Asian Spine Journal
                Publisher: Korean Society of Spine Surgery
                ISSN (Print): 1976-1902
                ISSN (Electronic): 1976-7846
                Publication date (Print): April 2018
                Publication date (Electronic): 16 April 2018
                Volume: 12
                Issue: 2
                Pages: 224-231
                Affiliations
                Department of Radiodiagnosis, Stanley Medical College, Chennai, India.
                Author notes
                Corresponding author: Suhasini Balasubramaniam. Department of Radiodiagnosis, Govt Stanley Medical College, Old Jail Road, Old Washermanpet, Chennai 600001, India. Tel: +91-9884877622, Fax: +91-04425282350, amarrd02@ 123456yahoo.co.in
                Article
                DOI: 10.4184/asj.2018.12.2.224
                PMC ID: 5913012
                PubMed ID: 29713402
                SO-VID: 58b13ac3-393e-47ba-b483-c3a0a264f20b
                Copyright © Copyright © 2018 by Korean Society of Spine Surgery
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 April 2017
                Date revision received : 10 June 2017
                Date accepted : 12 June 2017
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Orthopedics
                Keywords: dorsal spinal cord,ventral displacement,adhesion,arachnoid web,arachnoid cyst
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: dorsal spinal cord, ventral displacement, adhesion, arachnoid web, arachnoid cyst

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