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Ventral thoracic spinal cord hernia repair

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Ventral spinal cord herniation (vSCH) is a rare condition in which the spinal cord herniates through a defect in the dura mater.

This condition is most commonly seen in the thoracic region of the spinal cord.

vSCH can be idiopathic, congenital or acquired resulting from factors such as degenerative disc disease and prolapse, trauma or previous surgical intervention.

The spinal cord herniation can lead to a tethering effect on the spinal cord that is driven by cerebrospinal fluid pulsation and a pressure gradient between the intradural and extradural compartments. As a result, progressive neurological symptoms can develop due to compromised blood supply similar to a strangulated hernia elsewhere in the body. Untreated, progressive erosion of the vertebral body may occur.

Diagnosis can often be delayed due to insidious onset of symptoms, and a low index of clinical suspicion.

Surgical treatment is complex intradural exploration. This is a rare pathology with high risk of worsening neurological morbidity, and should be only be performed in specialist centres with expertise in intradural surgery.

Author: Mark Nowell FRCS

Institution: Southmead Hospital, Bristol, UK.

Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.

In the USA contact: fda.gov
In the UK contact: gov.uk
In the EU contact: ema.europa.eu

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