• Randall J Hlubek, David S Xu, Celene B Mulholland, Jourdan Gilson, Nicholas Theodore, Jay D Turner, and U Kumar Kakarla.
• Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
• Oper Neurosurg (Hagerstown). 2019 Apr 1; 16 (4): 415-423.

BackgroundIdiopathic spinal cord herniation (ISCH) is a rare pathology of the spine defined by herniation of the spinal cord through a dural defect.ObjectiveTo highlight the operative management of ISCH and the surgical nuances of ISCH repairs conducted at our institution.MethodsThis retrospective review examines consecutive patients with ISCH who were treated surgically between January 1, 2010, and July 31, 2017, at Barrow Neurological Institute, Phoenix, Arizona.ResultsFour patients with ISCH presented with thoracic myelopathy and lower extremity weakness during the study period. Treatment consisted of reduction of the herniated spinal cord and filling of the dural defect with a collagen-based dural regeneration matrix. In 3 patients the dural edges were covered with a collagen-matrix intradural sling, and in 1 patient they were repaired primarily with interrupted sutures. Three of the 4 patients experienced improvement in myelopathic symptoms; the fourth patient suffered neurological decline in the immediate postoperative period.ConclusionISCH is a complex pathological condition likely to result in progressive myelopathy. Surgery offers patients the possibility of stabilizing the progression of the spinal cord dysfunction and perhaps restoring neurological function. However, extreme care must be taken during surgery to minimize manipulation of the fragile herniated cord.Copyright © 2018 by the Congress of Neurological Surgeons.

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