Surgical Treatment of Idiopathic spinal cord herniation: A Case Report under Neuromonitoring and Meta-analysis of 211 reviewed Cases

Journal article

BackgroundIdiopathic spinal cord herniation (ISCH) is a rare condition caused by a ventral or ventrolateral dural defect. Two surgical strategies are used: non-closure (Group I), consisting of reduction and adhesiolysis with or without enlargement of the defect, and closure (Group II), involving reduction followed by direct or indirect dural repair. This study compared these approaches.MethodsWe reported a case of ISCH treated under neuromonitoring. We conducted a systematic review and meta-analysis including surgically treated cases confirmed by MRI or CT myelography, excluding traumatic, iatrogenic, and discogenic etiologies. Outcomes included neurological status at final follow-up, recurrence, and surgical complications.ResultsA 50-year-old patient with progressive Brown-Séquard syndrome underwent surgery; neuromonitoring deterioration during attempted closure prompted conversion to non-closure. At the final follow-up, a clinical improvement without recurrence or complications was observed. Through the review, we identified 211 patients, including our case (mean age 50.99 ± 13.25 years; 58.7% female). Median follow-up was 24.16 months. In Group I, 53 improved, 4 were unchanged, and 2 worsened; in Group II, 114 improved, 27 were unchanged, and 9 worsened. Non-closure was associated with higher odds of improvement in the unadjusted analysis (POR 2.74, 95% CI 1.09-6.90, p = 0.032), but this association attenuated after adjustment (adjusted POR 2.53, 95% CI 0.69-9.31, p = 0.16). Complication rates were 3.38% vs 8.00% (OR 0.40, 95% CI 0.04-1.90); recurrence occurred once in each Group.ConclusionsBoth strategies are comparable. The non-closure could be a better choice, since it requires less manipulation. Intraoperative neuromonitoring is a valuable decision-making tool in ISCH surgery.

Authors: Elmuradova, U; Omran, Z; Hammersen, S; Kantelhardt, SR; Mulhem, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Brain and Spine
• Volume: 6
• Pages: 105958
• Article number: 105958
• Publication date: 2026-02-02
• DOI: 10.1016/j.bas.2026.105958
• EISSN: 2772-5294
• ISSN: 2772-5294
• Pmid: 41716878
• Language: English
• Keywords: Thoracic Spinal Cord Herniation; Neuromonitoring; Systematic review; Ventral Spinal Cord Herniation; Idiopathic Spinal Cord Herniation; Anterior Spinal Cord Herniation