title: Spinal cord herniation: management and outcome in a series of 12 consecutive patients and review of the literature.
abstract: BACKGROUND
  Spinal cord herniation is a rare entity that has been recognized and described with increasing frequency in the past few years. It is characterized by herniation of the spinal cord through an anterior dural defect. In their study of 12 cases, the authors attempt to develop management and treatment guidelines for patients suffering from this condition.
  
  
  METHODS
  A retrospective analysis of the medical files was carried out in a series of 12 consecutive patients treated at our Institution between 1998 and 2011 for spinal cord herniation. The clinical, radiological and surgical findings, management and outcome were reviewed.
  
  
  RESULTS
  The male:female ratio was 5:7, with a mean age of 47 years (range 26–71 years). All patients presented a progressively worsening symptomatology. Symptoms at presentation included progressive myelopathy, corticospinal tract sign, algoparesthesia and sphincter dysfunction. The radiological appearance was uniform. All the lesions were located between the T2 and T8 vertebrae. One patient was initially managed conservatively. All patients underwent surgical correction via a posterior approach, with reduction of the herniated spinal cord, the positioning of a muscular autograft to fill the anterior cavity and closure of the dural defect with an artificial dural patch. Six patients showed improvement of preoperative symptomatology at follow-up, while the others remained free from symptom progression.
  
  
  CONCLUSIONS
  The authors present one of the largest studies to date regarding patients with spinal cord herniation and emphasize that the possibility of this condition must be kept in mind when addressing all patients with progressive myelopathy.
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy. francesco.prada@istituto-besta.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Prada
authors.forename: Andrea
authors.initials: A
authors.lastname: Saladino
authors.forename: Sergio
authors.initials: S
authors.lastname: Giombini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Erbetta
authors.forename: Marco
authors.initials: M
authors.lastname: Saini
authors.forename: Francesco
authors.initials: F
authors.lastname: DiMeco
authors.forename: Sandro
authors.initials: S
authors.lastname: Lodrini
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011859:Radiography; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome