Abstract
Introduction: Although relatively rare, the occurrence of idiopathic spinal cord hernia (ISCH) cases continue to rise due to advances in diagnostics techniques. Here, we report on the feasibility of ultrasonography during ISCH surgery.
Case report: A 47-year-old man with no history of spinal pathology developed Brown-Séquard syndrome. Magnetic resonance imaging (MRI) revealed an attachment between his spinal cord and the vertebral body at the T4/5 level. Tumors and cystic lesions were excluded on computed tomography (CT) and myelographic examination. The patient was subsequently diagnosed with ISCH and underwent surgery. After laminectomy at T3/5, we performed an ultrasonogram of the epidural space. Results showed that the spinal cord was attached to the vertebral body at the T4/5 level which showed no signs of pulsation. On opening the dura mater, ultrasonography revealed attachment of an ostensibly unremarkable spinal cord. We therefore released the spinal cord and patched with the fascia. On closing the dura mater, ultrasonography confirmed a return of pulsation and improvement in the shape of the spinal cord.
Conclusion: Although the thoracic cord appeared macroscopically normal after dural incision, further intervention was actually required. Intraoperative ultrasonography was found to be useful in ISCH surgery, both for positional identification and as a checkpoint for further surgical manipulation.
