Iatrogenic postoperative spinal cord herniation: A report of two cases and review of the literature.

BACKGROUND

Iatrogenic spinal cord herniation is an exceptionally rare complication following spinal surgery involving durotomy. Failure of watertight dural closure may lead to pseudomeningocele formation and progressive spinal cord tethering, ultimately resulting in herniation and neurological deterioration.

CASE DESCRIPTION: We report two cases of postoperative spinal cord herniation. A 36-year-old male developed acute conus medullaris herniation 2 weeks after surgical resection of a cystic lesion, presenting with paraparesis, sensory loss, and sphincter dysfunction. A 68-year-old male presented with delayed cervical spinal cord herniation 19 months after C5-C7 meningioma resection, manifesting with progressive paresthesia on all four limbs. Magnetic resonance imaging demonstrated herniation of the spinal cord through a dorsal dural defect in both patients. Surgical revision consisted of extension of the previous durotomy, microsurgical lysis of arachnoid adhesions, reduction of the herniated spinal cord, and watertight dural repair using non-absorbable sutures reinforced with a collagen dural substitute and fibrin sealant. Both patients experienced significant neurological recovery, with complete symptomatic resolution in the cervical case.

CONCLUSION

Postoperative spinal cord herniation requires a high index of suspicion in any patient with delayed neurological deterioration after spinal surgery. Early surgical untethering with watertight dural closure is essential to prevent permanent deficits; pseudomeningoceles identified on postoperative imaging warrant radiological surveillance until resolution.