Ventral Herniation of the Cervical Cord After Single-Level Corpectomy
Ventral Herniation of the Cervical Cord After Single-Level Corpectomy
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DOI：
10.1016/j.wneu.2019.12.165
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发表时间：
2020-04-01
影响因子：
2
通讯作者：
Schaible, Keith
中科院分区：
文献类型：
--
作者：
Finneran, Megan M.;Schaible, Keith
背景：颈椎脊髓突出症是一种罕见的疾病。它最常与手术有关，而且几乎完全与后路手术有关。报道了3例多节段椎体切除术后前路突出，均为手术中硬脑膜缺损所致的突出。病例描述：一位49岁的男性患者在急诊室出现全身疲劳。17年前，他因椎板切除后出现的颈椎后凸畸形，曾接受过C5椎体前路切除和C2-T4颈椎后路融合术。颈椎核磁共振成像显示C5腹侧椎体切除部位有明显的脊髓腹侧突出。患者接受了C4-6椎体切除，C3-7椎体前路重建、融合和内固定，成功地复位并解剖重整了脊髓突出物。结论：我们报告了一例颈髓突出症，发生在脊髓腹侧切除部位，没有明显的硬脑膜缺陷。我们假设，随着时间的推移，脑脊椎搏动会使椎体切除部位退化，并最终促进脊髓突出。在这里，我们讨论成功的手术治疗这种独特的病理，并讨论相关的文献回顾。
BACKGROUND: Spinal cord herniation in the cervical spine is an exceptionally rare occurrence. It is most often cited in association with surgery and almost exclusively with a posterior approach. Herniation with an anterior approach has been reported in 3 cases after multilevel corpectomy, all of which involved herniation through a dural defect sustained during surgery.CASE DESCRIPTION: A 49-year-old man presented to the emergency room generalized fatigue. He had a previous anterior C5 corpectomy and posterior cervical fusion from C2-T4 performed 17 years prior for a cervical kyphotic deformity that developed after a laminectomy. Magnetic resonance imaging of the cervical spine demonstrated a significant ventral cord herniation into the C5 ventral corpectomy site. The patient underwent a C4-6 vertebral corpectomy with C3-7 anterior reconstruction, fusion, and instrumentation with successful reduction and anatomic realignment of the spinal cord herniation.CONCLUSIONS: We present a case of cervical cord herniation that occurred the ventral corpectomy site without obvious dural defect. We hypothesize that cerebral spinal pulsations over time degraded the corpectomy site and ultimately promoted herniation of the spinal cord. Here, we discuss the successful surgical management of this unique pathology and discuss a relevant review of the literature.