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| NEUROIMAGES |
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| Year : 2016 | Volume
: 64
| Issue : 4 | Page : 831-832 |
Idiopathic ventral herniation of the spinal cord
Suprava Naik, Alok K Udiya, Gurucharan S Shetty, Rajendra V Phadke, Vivek Singh, Sunil K Jain, Shweta Singhal
Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 5-Jul-2016 |
Correspondence Address:
Dr. Alok K Udiya
Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.185363
How to cite this article:
Naik S, Udiya AK, Shetty GS, Phadke RV, Singh V, Jain SK, Singhal S. Idiopathic ventral herniation of the spinal cord. Neurol India 2016;64:831-2 |
We present a case of 45-year-old male who presented with gradual onset difficulty in walking. The patient underwent magnetic resonance imaging (MRI) of the spine for further evaluation. Idiopathic spinal cord herniation is a rare spontaneous displacement of thoracic cord through an anterior dural defect. Several theories have been proposed for the development of this condition; however, the exact pathogenesis remains unclear. Three types of ventral herniation have been described in the literature; defect in the ventral layer of duplicated dura, epidural cyst or pseudomeningocele, and direct epidural spinal cord herniation.[1]
Spinal cord herniation usually occurs in the thoracic spine at D4–D5 level, which can be explained by the normal kyphosis of thoracic spine, natural anterior position of the thoracic spinal cord, physiological anterior movement of the spinal cord secondary to cardiac and pulmonary actions, and the impact of flexion and extension movements.[2] It typically presents in middle aged adults as Brown-Séquard syndrome, postural headaches, and, if untreated, can ultimately progress to spastic paraparesis.
MRI is the gold standard technique for the diagnosis of spinal cord herniation. On sagittal MRI, typical features are ventral displacement, sharp ventral angulation of thoracic spinal cord, and enlargement of dorsal subarachnoid space [Figure 1].[3] | Figure 1: Magnetic resonance imaging sagittal T2 (a) and fat sat (b) images showing loss of ventral subarachnoid space at the D5 vertebral level, with the corresponding axial T2 image (c) at this level showing close approximation of the cord substance to the ventral dura
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Differential diagnosis for this condition includes dorsal spinal arachnoid cyst and dorsal spinal web. In case of a spinal web, the indentation on the dorsal spinal cord is very focal, which is described as “scalpel like.” Phase contrast MRI is useful in differentiating these conditions from spinal cord herniation. In spinal cord herniation, a normal cerebrospinal fluid (CSF) pulsatile pattern is observed within the dorsal subarachnoid spaces; this pattern is absent on the ventral side at the level of the herniation. However, in case of a dorsal cyst or a dorsal web, local alterations in CSF flow dynamics are observed in the dorsal subarachnoid space. Thus, phase-contrast MRI clinches the diagnosis without the need for an invasive diagnostic study such as CT myelography.[4] In our case, the imaging showed no well-defined lesion dorsal to the spinal cord. Normal CSF flow artefacts were apparent dorsal to the cord at this level, which led us to suspect a ventral cord herniation.
Treatment of choice for this condition is surgical closure of the dural defect and reduction of the adhered cord with minimal cord manipulation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Aizawa T, Sato T, Tanaka Y, Kotajima S, Sekiya M, Kokubun S. Idiopathic herniation of the thoracic spinal cord: Report of three cases. Spine 2001;26:488-91.  |
| 2. | Masuzawa H, Nakayama H, Shitara N, Suzuki T. Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome: Case report. J Neurosurg 1981;55:983-6. [ PUBMED] |
| 3. | Massicotte EM, Montanera W, Ross Fleming JF, Tucker WS, Willinsky R, TerBrugge K, et al. Idiopathic spinal cord herniation: Report of eight cases and review of the literature. Spine 2002;27:233-41. |
| 4. | Saito A, Takahashi T, Sato S, Kumabe T, Tominaga T. Modified surgical technique for the treatment of idiopathic spinal cord herniation. Minim Invasive Neurosurg 2006;49:120-3. |
[Figure 1]
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