Role of expansile duraplasty and neural monitoring in surgery for Anterior Thoracic Spinal Cord Herniation

摘要

Anterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive neurological dysfunction of lower limbs where a portion of spinal cord tissue herniates through a ventral dural defect. We report a 19-year adolescent male who presented with myelopathy (Frankel D) secondary to ATSCH at D7 level and managed surgically by Anterior Patching of Dura. He worsened neurologically on the first post-operative day to Frankel B secondary to spinal cord oedema and underwent decompressive expansile duraplasty. The use of bedside neural monitoring helped in timely re-exploration and prognostication, as the patient recovered to normal neurological status in 6?months. This case report is to emphasise on considering the option of Expansile duraplasty while closing the posterior durotomy in ATSCH of more than 10?mm to prevent post-operative neurological worsening. Apart from its intra-operative applicability, electrophysiological testing could be an useful bedside tool to prognosticate neurological events in ATSCH.