title: Surgical management of thoracic spinal cord herniation: technical consideration.
abstract: METHODS
  This report describes a case of spinal cord herniation (SCH) and the surgical technique used to repair the herniation.
  
  
  OBJECTIVE
  To describe a new surgical technique used to provide increased exposure to minimize spinal cord traction for safe repair of the ventral dural defect.
  
  
  BACKGROUND
  SCH is a relatively rare pathologic condition that is frequently misdiagnosed. It is characterized by the spontaneous herniation and tethering of the spinal cord through a ventral dural defect. A limitation of current surgical management is sufficient exposure of the defect through which the cord herniates.
  
  
  METHODS
  This technique entails a posterior decompressive laminectomy and bilateral transpedicular approach, followed by unilateral removal of the pedicle and transverse processes to sufficiently expose the dural defect and SCH. A Gore-Tex graft is then used to repair the dural defect.
  
  
  RESULTS
  This approach provided greater exposure of the ventral dural defect and anterior spinal cord, and allowed for safer dissection of dural adhesions. By releasing these adhesions, the spinal cord was returned to its normal position in the thecal sac. The dural defect was then repaired with minimal manipulation of the spinal cord.
  
  
  CONCLUSIONS
  We present a rare case of SCH. We describe a new technique used to repair SCH, which adds to the repertoire of existing surgical techniques. By providing a wide exposure, this approach provides wide access to the ventral thecal sac, thus minimizing the requirement for cord traction and allowing for safer closure of the dural defect.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Kaisorn L
authors.initials: KL
authors.lastname: Chaichana
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Khan W
authors.initials: KW
authors.lastname: Li
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D019468:Disease Management; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging; D059685:Herniorrhaphy; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008875:Middle Aged; D011859:Radiography; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*