Surgical Management of Thoracic Spinal Cord Herniation Technical Consideration
Surgical Management of Thoracic Spinal Cord Herniation Technical Consideration
复制标题
DOI：
10.1097/bsd.0b013e318165fe2a
复制
发表时间：
2009-02-01
影响因子：
--
通讯作者：
Gokaslan, Ziya L.
中科院分区：
文献类型：
--
作者：
Chaichana, Kaisorn L.;Sciubba, Daniel M.;Gokaslan, Ziya L.
研究设计：本报告描述了一个脊髓突出症(SCH)的病例和用于修补该突出物的外科技术。目的：描述一种新的外科技术，用于提供更大的暴露，最大限度地减少脊髓牵引力，从而安全地修复腹侧硬脑膜缺损。背景资料摘要：SCH是一种相对罕见的病理情况，经常被误诊。它的特点是脊髓通过腹侧硬脑膜缺损处自发突出和拴系。目前手术治疗的局限性是充分暴露脊髓突出的缺损区。方法：这种技术需要后路椎板减压和双侧椎弓根入路，然后切除单侧椎弓根和横突，以充分暴露硬脑膜缺损区和脊髓。结果：该入路能更好地显露腹侧硬脑膜缺损和脊髓前部，并能更安全地剥离硬脑膜粘连。通过释放这些粘连，脊髓恢复到其在膜囊中的正常位置。硬脑膜缺损处随后用最小的脊髓操作修复。结论：我们报道了一例罕见的脊髓硬脑膜损伤。我们描述了一种用于修复SCH的新技术，它增加了现有外科技术的保留范围。通过提供广泛的暴露，该入路提供了通向腹侧膜囊的广泛通道，从而最大限度地减少了对脊髓牵引的需求，并允许I-或更安全地闭合硬脑膜缺损。
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 I-or safer Closure of the dural defect.