The spinal canal is not massed, but the spinal cord is "flattened": a rare spinal cord hernia

Figure 1 The photo above shows the AJNR Journal May case, the patient is 62 years old, the left thoracic and left leg pain, left limb weakness, urinary and urinary disorders

This morphological change of the spinal cord is very similar to the forward compression of the posterior mass of the spinal cord in the spinal canal, and if the corresponding horizontal subarachnoid space is widened behind the spinal cord, the internal is a normal cerebrospinal fluid signal, and there is no tumor or cyst formation, so why does this phenomenon occur? What disease has such imaging signs?

Similar cases

Figure 2 The imaging of the above icons is similar, resulting in the same disease

Case results

SpinalCord Herniation (SCH)

It is relatively rare in the clinic and can be divided into three categories: idiopathic, postraumatic, and iatrogenic, and the results of all of the above cases are idiopathic spinal cord hernias

Figure 3 Case 1 Picture of surgery and MRI results of postoperative review

Clinical manifestations

The most common signs are Brown-Sequard syndrome, slow onset, palphea of the body on one side, weakness in the contralateral limbs, proprioceptional disturbances such as vibration and position, and spastic paresis

pathogenesis

There are congenital developmental defects in the dura on the ventral side of the spinal cord or secondary to acquired chronic injury, there is a slight local defect, spinal cord pulsation formed with breathing and heartbeat, in the presence of thoracic kyphosis, the point of stress is concentrated on the ventral side of the dural capsule, and the spinal cord is herniated forward or anterior through the dural defect for a long time, and the manifestation of

Figure 4 shows a schematic of spinal cord hernia

Imaging presentation

Lesions occur most often at the T2-10 level;

The sagittal position shows that the lesion segment spinal cord has a "C" nodular shape, and the dorsal subarachnoid space is enlarged;

The transverse dissection shows that the lesion segment spinal cord is slightly thinner, curved into an angle, and the subdural space is "double myeloid sign" to the anterior or anterior side of the hernia, and the local subarachnoid space is absent

differential diagnosis

Mainly distinguished from the dorsal dural arachnoid cyst on the dorsal side of the spinal cord, when the cyst occurs, although the spinal cord is deformed, there are many horned changes, the spinal cord is "compressed" lightly, and the subarachnoid space

Figure 5 Case of an intradural cyst on the dorsal side of the spinal cord

treat

Mainly through surgical treatment, the main surgical methods are: (1) direct suturing of the hernia; (2) Hernia sac enlargement; (3) Hernia sac dural repair, etc

summary

Local anterior displacement of the thoracic spinal cord, thinning, angular walking, dorsal subarachnoid enlargement, no mass formation, and patients with Brown-Sequard syndrome, the possibility