Surgical management of idiopathic spinal cord herniation: a review of ninecases treated by the enlargement of the dural defect

Object. Spinal cord herniation is a rare cause of progressive myelopathy an d can be corrected surgically. In most previous reports, closure of the dur al defect was the recommended procedure. The object of this paper is to des cribe a new procedure in which spinal cord constriction is released by enla rging the hiatus; additionally the postoperative results will be discussed. Methods. In nine patients with spinal cord herniation, enlargement of the d ural defect was performed. In eight patients, neurological deficits resolve d immediately after surgery. In one patient with a severe preoperative neur ological deficit whose spinal cord herniated massively, deterioration occur red postoperatively. To date, no recurrence of herniation has been observed . Conclusions. The goals of surgery are to reduce the herniation, return the spinal cord to the normal position, and prevent the recurrence of herniatio n. The use of sutures to close the dural defect has been the method of choi ce to date. The surgical space in front of the spinal cord, however, is ins ufficient to accommodate this procedure safely. Because symptoms are caused by the constriction of the spinal cord at the hiatus, surgical expansion o f the hiatus allows the goals of surgery to be achieved. This procedure, wh ich is technically easier and less invasive with regard to the vulnerable s pinal cord than the closure of the dural defect, could be a viable alternat ive for the treatment of this rare disease.