• Groen Rob J M RJM Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: r.j.m.groen@um, Jertske N M Lukassen, Gert Jan Boer, Rob A Vergeer, Maarten H Coppes, Gea Drost, and Berrie Middel.
• Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: r.j.m.groen@umcg.nl.
• World Neurosurg. 2019 Mar 1; 123: 453-463.e15.

BackgroundAnterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive myelopathy. Early surgery is essential, but there is no agreement about the best surgical approach.ObjectiveTo identify factors that determine surgical results and to find evidence for the most favorable technique to correct ATSCH.MethodsTo find relevant literature, computed databases of PubMed, EMBASE, and ISI Web of Science were searched. The study comprised case reports published between 1974 and 2018, and the data set was completed with 12 cases treated in our own institute. Patient characteristics were analyzed following the principles of an individual participant data meta-analysis.ResultsBrown-Séquard-like neurologic deficit before surgery was associated with postoperative motor function improvement compared with patients with paraparesis (P = 0.04). In the univariate analysis, widening of the dura defect (WDD) was more prevalent among improved patients, whereas anterior dura patch and application of intraoperative neurophysiologic monitoring were not. In the multivariate analysis, the favorable association with WDD disappeared, which is explained by the dominant influence of a Brown-Séquard-like deficit on outcome.ConclusionsIn general, postoperative results after surgery for ATSCH are favorable, with a high percentage of patients experiencing postoperative improvement. Postoperative motor function improvement is more likely to occur in patients with a Brown-Séquard-like neurologic deficit. The WDD should be favored above the application of a patch as the technique of choice in surgical treatment of ATSCH.Copyright © 2018 Elsevier Inc. All rights reserved.

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