Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Natural history and surgical outcomes of idiopathic spinal cord herniation

Spinal Cord volume 61, pages 441–446 (2023)Cite this article

Subjects

Abstract

Study design

Retrospective multicenter study.

Objectives

Although surgery is frequently selected for the treatment of idiopathic spinal cord herniation (ISCH), its impact on functional outcomes has yet to be fully understood given the limited number of patients in previous studies. This study aims to evaluate the symptomatic history and surgical outcomes of ISCH.

Setting

Three institutions in Japan.

Methods

A total of 34 subjects with ISCH were retrospectively enrolled and followed up for at least 2 years. Demographic information, imaging findings, and clinical outcomes were collected. Functional status was assessed using the JOA score.

Results

The types of neurologic deficit were monoparesis, Brown–Sequard, and paraparesis in 5, 17, and 12 cases, with their mean disease duration being 1.2, 4.2, and 5.8 years, respectively. Significant differences in disease duration were observed between the monoparesis and Brown–Sequard groups (p < 0.01) and between the monoparesis and paraparesis groups (p = 0.04). Surgery promoted significantly better recovery rates from baseline. Correlations were observed between age at surgery and recovery rate (p < 0.01) and between disease duration and recovery rate (p = 0.04). The mean recovery rates were 82.6%, 51.6%, and 29.1% in the monoparesis, Brown–Sequard, and paraparesis groups, respectively. The monoparesis group had a significantly higher recovery rate than did the Brown–Sequard (p = 0.045) and paraparesis groups (p < 0.01).

Conclusions

Longer disease duration was correlated with the progression of neurologic deficit. Older age, and worse preoperative neurologic status hindered postoperative functional recovery. These results highlight the need to consider surgical timing before neurologic symptoms deteriorate.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Correlation between disease duration and type of neurological deficit.
Fig. 2: Pre and postoperative T2-weighted MR imaging of dural defect enlargement and duraplasty.
Fig. 3: Clinical factors that affected the JOA recovery rate.
Fig. 4: Schematic diagram of the expected disease progression of ISCH.

Similar content being viewed by others

Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Wortzman G, Tasker RR, Rewcastle NB, Richardson JC, Pearson FG. Spontaneous incarcerated herniation of the spinal cord into a vertebral body: a unique cause of paraplegia. Case report. J Neurosurg. 1974;41:631–5.

    Article  CAS  PubMed  Google Scholar 

  2. Barrenechea IJ, Lesser JB, Gidekel AL, Turjanski L, Perin NI. Diagnosis and treatment of spinal cord herniation: a combined experience. J Neurosurg Spine. 2006;5:294–302.

    Article  PubMed  Google Scholar 

  3. Berg-Johnsen J, Ilstad E, Kolstad F, Zuchner M, Sundseth J. Idiopathic ventral spinal cord herniation: an increasingly recognized cause of thoracic myelopathy. J Cent Nerv Syst Dis. 2014;6:85–91.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Groen RJ, Middel B, Meilof JF, de Vos-van de Biezenbos JB, Enting RH, Coppes MH, et al. Operative treatment of anterior thoracic spinal cord herniation: three new cases and an individual patient data meta-analysis of 126 case reports. Neurosurgery. 2009;64:ons145–59.

    PubMed  Google Scholar 

  5. Hassler W, Al-Kahlout E, Schick U. Spontaneous herniation of the spinal cord: operative technique and follow-up in 10 cases. J Neurosurg Spine. 2008;9:438–43.

    Article  PubMed  Google Scholar 

  6. Imagama S, Matsuyama Y, Sakai Y, Nakamura H, Katayama Y, Ito Z, et al. Image classification of idiopathic spinal cord herniation based on symptom severity and surgical outcome: a multicenter study. J Neurosurg Spine. 2009;11:310–9.

    Article  PubMed  Google Scholar 

  7. Maira G, Denaro L, Doglietto F, Mangiola A, Colosimo C. Idiopathic spinal cord herniation: diagnostic, surgical, and follow-up data obtained in five cases. J Neurosurg Spine. 2006;4:10–9.

    Article  PubMed  Google Scholar 

  8. Massicotte EM, Montanera W, Ross Fleming JF, Tucker WS, Willinsky R, TerBrugge K, et al. Idiopathic spinal cord herniation: report of eight cases and review of the literature. Spine. 2002;27:E233–41.

    Article  PubMed  Google Scholar 

  9. Nakamura M, Fujiyoshi K, Tsuji O, Watanabe K, Tsuji T, Ishii K, et al. Long-term surgical outcomes of idiopathic spinal cord herniation. J Orthop Sci. 2011;16:347–51.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Prada F, Saladino A, Giombini S, Erbetta A, Saini M, DiMeco F, et al. Spinal cord herniation: management and outcome in a series of 12 consecutive patients and review of the literature. Acta Neurochir. 2012;154:723–30.

    Article  PubMed  Google Scholar 

  11. Watanabe M, Chiba K, Matsumoto M, Maruiwa H, Fujimura Y, Toyama Y. Surgical management of idiopathic spinal cord herniation: a review of nine cases treated by the enlargement of the dural defect. J Neurosurg. 2001;95:169–72.

    CAS  PubMed  Google Scholar 

  12. Groen RJM, Lukassen JNM, Boer GJ, Vergeer RA, Coppes MH, Drost G, et al. Anterior thoracic spinal cord herniation: surgical treatment and postoperative course. an individual participant data meta-analysis of 246 Cases. World Neurosurg. 2019;123:453–63.e15.

    Article  PubMed  Google Scholar 

  13. Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine. 1981;6:354–64.

    Article  CAS  PubMed  Google Scholar 

  14. Aizawa T, Sato T, Tanaka Y, Kotajima S, Sekiya M, Kokubun S. Idiopathic herniation of the thoracic spinal cord: report of three cases. Spine. 2001;26:E488–91.

    Article  CAS  PubMed  Google Scholar 

  15. Nakazawa H, Toyama Y, Satomi K, Fujimura Y, Hirabayashi K. Idiopathic spinal cord herniation. Report of two cases and review of the literature. Spine. 1993;18:2138–41.

    Article  CAS  PubMed  Google Scholar 

  16. Zappala M, Lightbourne S, Heneghan NR. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. J Orthop Surg Res. 2021;16:447.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ohtake Y, Senoo M, Fukuda M, Ishida Y, Yoshihara R, Ishikawa K, et al. Symptomatic interdural cerebrospinal fluid collections after surgery for idiopathic spinal cord herniation: illustrative case. J Neurosurg Case Lessons. 2021;2:CASE21232.

    PubMed  PubMed Central  Google Scholar 

  18. Gaudino S, Colantonio R, Schiarelli C, Martucci M, Calandrelli R, Botto A, et al. Postoperative MR imaging of spontaneous transdural spinal cord herniation: expected findings and complications. AJNR Am J Neuroradiol. 2016;37:558–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Nakashima H, Kanemura T, Yagi H, Kato F, Sato K, Kamiya M, et al. Factors affecting the severity of neurological disorders in thoracic idiopathic spinal cord herniation. Spine. 2018;43:1552–8.

    Article  PubMed  Google Scholar 

Download references

Funding

Funding

No funds were received in support of this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino-shi, Tokyo, 191-0062, Japan

    Yuichiro Hirose

  2. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Narihito Nagoshi, Osahiko Tsuji, Satoshi Suzuki, Yohei Takahashi, Satoshi Nori, Mitsuru Yagi, Morio Matsumoto, Masaya Nakamura & Kota Watanabe

  3. Department of Orthopaedic Surgery, Keiyu Orthopedic Hospital, 2267-1 Akodacho, Tatebayashi-shi, Gunma, 374-0013, Japan

    Hitoshi Kono

  4. Department of Orthopaedic Surgery, Kitasato Institute Hospital, Department of Orthopaedic Surgery, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan

    Tsuyoshi Iida

Authors
  1. Yuichiro Hirose
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Narihito Nagoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osahiko Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hitoshi Kono
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsuyoshi Iida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Satoshi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yohei Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Satoshi Nori
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mitsuru Yagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Morio Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masaya Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kota Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YH and NN designed the research. YH, NN, HK, TI performed data collection. YH and NN analyzed the data and wrote the paper. OT, HK, TI, SS, YT, SN, MY, MM, MN, and KW supervised the study. All authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Narihito Nagoshi.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics

This study received ethical approval from the institutional review boards of the participating institutions (20110142). Informed consent was obtained from all subjects

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirose, Y., Nagoshi, N., Tsuji, O. et al. Natural history and surgical outcomes of idiopathic spinal cord herniation. Spinal Cord 61, 441–446 (2023). https://doi.org/10.1038/s41393-023-00904-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-023-00904-3

Search

Advanced search

Quick links