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Xu Y, Zhang Y, Luo Y, Qiu G, Liu Y, Zhao W, Wang Y. Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review. J Int Med Res 2022; 50:3000605221110069. [PMID: 35903859 PMCID: PMC9340934 DOI: 10.1177/03000605221110069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Brown-Séquard syndrome (BSS) has many etiologies, including penetrating trauma, extramedullary tumors, and disc herniation. However, thoracic ossification of the ligamentum flavum (OLF) is an extremely rare cause of this syndrome. A 46-year-old woman with motor weakness in her right lower extremity and urinary retention was admitted to our department. Based on the results of physical examination, computed tomography, and magnetic resonance imaging, a diagnosis of BSS with OLF was considered. The patient underwent urgent conservative treatment. BSS is a rare condition characterized by hemisection or hemicompression of the spinal marrow. The herein-described case of incomplete BSS due to OLF responded to conservative treatment. However, the successful nonoperative management of this case is insufficient evidence to consider it as the standard of care. Therefore, emergency laminectomy decompression remains the standard of care for BSS.
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Affiliation(s)
- Yeqiu Xu
- Department of Orthopedic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, Hangzhou, P.R. China.,Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yuanzhuang Zhang
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yinzhou Luo
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Guanzhen Qiu
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yize Liu
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Wei Zhao
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
| | - Yong Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, Hangzhou, P.R. China.,Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, P.R. China
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Iunes EA, Barletta EA, Suzuki FS, Barba Belsuzarri TA, de Araújo Paz D, Veiga de Castro Sparapani F, Onishi FJ, Cavalheiro S, Salati T, de Meldau Benites V, Riechelmann G, Joaquim AF. Idiopathic Ventral Spinal Cord Herniation: Video Report and Systematic Review. World Neurosurg 2020; 139:592-602. [PMID: 32376383 DOI: 10.1016/j.wneu.2020.04.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Idiopathic ventral spinal cord herniation (ISCH) is a rare disease; however, it is an important differential diagnosis. Its treatment presents some controversies. CASE DESCRIPTION We report on a 55-year-old woman who had been presenting with relevant back pain and leg weakness for the past 3 years and urinary incontinence for the past 3 months. Clinical examination disclosed paresis on the right inferior limb and right foot, as well as a T6-level painful hypoesthesia. Magnetic resonance imaging disclosed a T4/T5 ISCH. The patient underwent surgical decompression. During the procedure, we opened the arachnoid and cut the dentate ligaments of the spine, which considerably improved the mobility and safety of the procedure. In the early follow-up, our patient presented a partial improvement regarding the paresis grades and hypoesthesia pain relief on the left side. A video showing the surgical procedure and case evolution is presented. We also assembled literature reviews to compare our case with others. ISCH is becoming a more recognized cause of progressive thoracic myelopathy. However, this condition is still frequently misdiagnosed. Magnetic resonance imaging is the key for diagnosis. The objective of surgical treatment is to prevent myelopathy progression. The technique presented in this report is an appropriate surgical option, once it is a safer way to identify and treat the defect. The neurologic condition usually improves greatly after surgical treatment, especially when the patient presents positive predictive factors. CONCLUSIONS ISCH is being more recognized. The technique presented is an appropriate surgical option.
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Affiliation(s)
- Eduardo Augusto Iunes
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Enrico Affonso Barletta
- Medical School, Post Graduation Program, Pontifical Catholic University of Campinas, São Paulo, Brazil.
| | - Fernando Seiji Suzuki
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Telmo Augusto Barba Belsuzarri
- Neurosurgery Department, Medical School, Post Graduation Program, Pontifical Catholic University of Campinas, São Paulo, Brazil
| | - Daniel de Araújo Paz
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | | | - Franz Jooji Onishi
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Sergio Cavalheiro
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Thiago Salati
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | | | - Guilherme Riechelmann
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
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