Surgical management of thoracic spinal cord herniation: Technical consideration

STUDY DESIGN: This report describes a case of spinal cord herniation (SCH) and the surgical technique used to repair the herniation. OBJECTIVE: To describe a new surgical technique used to provide increased exposure to minimize spinal cord traction for safe repair of the ventral dural defect. SUMMARY OF BACKGROUND DATA: SCH is a relatively rare pathologic condition that is frequently misdiagnosed. It is characterized by the spontaneous herniation and tethering of the spinal cord through a ventral dural defect. A limitation of current surgical management is sufficient exposure of the defect through which the cord herniates. METHODS: This technique entails a posterior decompressive laminectomy and bilateral transpedicular approach, followed by unilateral removal of the pedicle and transverse processes to sufficiently expose the dural defect and SCH. A Gore-Tex graft is then used to repair the dural defect. RESULTS: This approach provided greater exposure of the ventral dural defect and anterior spinal cord, and allowed for safer dissection of dural adhesions. By releasing these adhesions, the spinal cord was returned to its normal position in the thecal sac. The dural defect was then repaired with minimal manipulation of the spinal cord. CONCLUSIONS: We present a rare case of SCH. We describe a new technique used to repair SCH, which adds to the repertoire of existing surgical techniques. By providing a wide exposure, this approach provides wide access to the ventral thecal sac, thus minimizing the requirement for cord traction and allowing for safer closure of the dural defect.