title: Spontaneous resolution of idiopathic thoracic spinal cord herniation: case report.
abstract: Spinal cord herniation is a relatively rare but increasingly recognized clinical entity, with fewer than 200 cases reported in the literature to date. The etiology of this condition remains unknown, and surgery is used as the primary treatment to correct the herniation and consequent spinal cord compromise. Some patients without clinical progression have been treated with nonoperative measures, including careful follow-up and symptomatic physical therapy. To date, however, there has been no published report on the resolution of spinal cord herniation without surgical intervention. The patient in the featured case is a 58-year-old man who presented with mild thoracic myelopathy and imaging findings consistent with idiopathic spinal cord herniation. Surprisingly, updated MRI studies, obtained to better delineate the pathology, showed spontaneous resolution of the herniation. Subsequent MRI 6 months later revealed continued resolution of the previous spinal cord herniation. This is the first report of spontaneous resolution of a spinal cord herniation in the literature. At present, the treatment of this disorder is individualized, with microsurgical correction used in patients with progressive neurological impairment. The featured case highlights the potential variability in the natural history of this condition and supports considering an initial trial of nonoperative management for patients with mild, nonprogressive neurological deficits.
authors.affiliation: University of Toronto;
authors.forename: Nardin
authors.initials: N
authors.lastname: Samuel
authors.affiliation: Division of Orthopedic Surgery, University of Toronto;
authors.forename: Christina L
authors.initials: CL
authors.lastname: Goldstein
authors.affiliation: Division of Neurosurgery, Spinal Program, University of Toronto;|Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Carlo
authors.initials: C
authors.lastname: Santaguida
authors.affiliation: Division of Neurosurgery, Spinal Program, University of Toronto;|Department of Genetics and Development, Toronto Western Hospital; and.|Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D006547:Hernia / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous; D013118:Spinal Cord Diseases / Q000473:pathology*; D013904:Thoracic Vertebrae
keywords: case study; idiopathic; nonoperative management; spinal cord herniation; thoracic