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Research ArticleSpine Imaging and Spine Image-Guided Interventions

Postoperative MR Imaging of Spontaneous Transdural Spinal Cord Herniation: Expected Findings and Complications

S. Gaudino, R. Colantonio, C. Schiarelli, M. Martucci, R. Calandrelli, A. Botto, M. Pileggi, E. Gangemi, G. Maira and C. Colosimo
American Journal of Neuroradiology October 2015, DOI: https://doi.org/10.3174/ajnr.A4537
S. Gaudino
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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R. Colantonio
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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C. Schiarelli
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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M. Martucci
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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R. Calandrelli
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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A. Botto
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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M. Pileggi
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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E. Gangemi
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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G. Maira
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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C. Colosimo
From the Institute of Radiology (S.G., R. Colantonio, C.S., M.M., R. Calandrelli, A.B., M.P., E.G., C.C.) and Institute of Neurosurgery (G.M.), Catholic University of Rome, Rome, Italy.
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Abstract

BACKGROUND AND PURPOSE: Spontaneous transdural spinal cord herniation is no longer a rare cause of myelopathy. The high frequency of diagnoses has led to an increase in the number of surgical procedures. The purpose of this study was to describe the spectrum of postoperative MR imaging findings concerning spontaneous transdural spinal cord herniation and to provide a practical imaging approach for differentiating expected changes and complications after an operation.

MATERIALS AND METHODS: We retrospectively reviewed MR images from 12 patients surgically treated for spontaneous transdural spinal cord herniation. Surgery comprised either dural defect enlargement or duraplasty procedures. Postoperative follow-ups included at least 3 (early, intermediate, late) MR imaging studies. MR images were analyzed with respect to 3 spinal compartments: intradural intramedullary, intradural extramedullary, and extradural. The meaning and reliability of changes detected on MR images were related to their radiologic and clinical evolution with time.

RESULTS: Spinal cord realignment has been stable since the early study, whereas spinal cord signal and thickness evolved during the following scans. Most extramedullary and extradural changes gradually reduced in later MR images. Three patients treated with dural defect enlargements experienced the onset of new neurologic symptoms. In those patients, late MR images showed extradural fluid collection and the development of pial siderosis.

CONCLUSIONS: Our findings demonstrate the spectrum of postoperative imaging findings in spontaneous transdural spinal cord herniation. Spinal cord thickness and signal intensity continued to evolve with time; most extramedullary postsurgical changes became stable. Changes observed in later images may be suggestive of complications.

Abbreviations

DDE
dural defect enlargement
E-MRI
early MR imaging
I-MRI
intermediate MR imaging
JOA
Japanese Orthopedic Association
L-MRI
late MR imaging
STSCH
spontaneous transdural spinal cord herniation
  • © 2016 American Society of Neuroradiology
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Cite this article
S. Gaudino, R. Colantonio, C. Schiarelli, M. Martucci, R. Calandrelli, A. Botto, M. Pileggi, E. Gangemi, G. Maira, C. Colosimo
Postoperative MR Imaging of Spontaneous Transdural Spinal Cord Herniation: Expected Findings and Complications
American Journal of Neuroradiology Oct 2015, DOI: 10.3174/ajnr.A4537

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Postoperative MR Imaging of Spontaneous Transdural Spinal Cord Herniation: Expected Findings and Complications
S. Gaudino, R. Colantonio, C. Schiarelli, M. Martucci, R. Calandrelli, A. Botto, M. Pileggi, E. Gangemi, G. Maira, C. Colosimo
American Journal of Neuroradiology Oct 2015, DOI: 10.3174/ajnr.A4537
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