Dorsal Spinal Cord Herniation Following Thoracic Laminectomy for Medulloblastoma Metastasis: A Case Report and Literature Review.

BACKGROUND

Dorsal spinal cord herniation is an exceptionally rare postoperative complication, most often associated with iatrogenic dural defects or adhesions, and may result in progressive neurological decline if not promptly recognized. Unlike the more frequently encountered idiopathic ventral subtype, dorsal herniation typically follows spinal intervention and requires early radiological suspicion in symptomatic patients.

REPORT OF CASE: A 14-year-old boy developed dorsal spinal cord herniation after thoracic laminectomy for medulloblastoma drop metastasis. Initial treatment included suboccipital craniectomy with complete tumor excision and craniospinal irradiation, with no evidence of spinal metastasis on imaging at the time of initial diagnosis and radiation planning. Four months after completing radiotherapy, he developed thoracic pain and progressive spastic weakness. Whole-spine magnetic resonance imaging (MRI) revealed newly developed diffuse cerebrospinal fluid metastatic deposits with maximal compression at T9 to T11, necessitating laminectomy and partial tumor removal. Postoperatively, he experienced worsening paraparesis, and a repeat MRI demonstrated dorsal spinal cord herniation at the operative level. Surgical revision with decompression was performed.

CONCLUSIONS

Postlaminectomy dorsal spinal cord herniation is a rare yet serious complication. It should be considered in any patient presenting with new or recurrent neurological deficits following spinal surgery. Prompt evaluation with spinal MRI, followed by timely surgical intervention, is crucial to prevent irreversible neurological injury and to optimize functional recovery.