Idiopathic Spinal Cord Herniation With Severe Adhesions Treated Using the Hammock Method - A Case Report

Sep 30, 2026

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Idiopathic spinal cord herniation is a rare cause of slowly progressive myelopathy requiring surgical management. This case report details a 63-year-old man with progressive sensory deficits, hyperactive reflexes with bilateral Babinski positivity, and urinary difficulty. MRI and CT myelography demonstrated a dural defect at the T4 level with extramedullary prolapse and anterior cord deviation. After T3–T6 laminectomy, dural patch closure using the hammock method was performed with intraoperative evoked-potential monitoring, resulting in no paralysis progression, disappearance of anterior deviation, and improved JOA score without recurrence over two years.

LanguageEnglish

CategoryHealthcare

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Reading Time18 min

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Abstract

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Introduction

Review began 08/19/2025 Review ended 10/13/2025 Published 12/08/2025 © Copyright 2025 Aizawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98678 Open Access Case Report Idiopathic Spinal Cord Herniation With Severe Adhesions Treated Using the Hammock Method: A Case Report Koki Aizawa 1, Masaki Tatsumura 1, Shun Okuwaki 1, Katsuya Nagashima 1, Yosuke Takeuchi 1 , Toru Funayama 2 1. Division of Spine Center, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Mito, JPN 2. Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN Corresponding author: Masaki Tatsumura, [tatsumura@md.tsukuba.ac.jp](tatsumura@md.tsukuba.ac.jp) Abstract Idiopathic spinal cord herniation has traditionally been considered a relatively rare disease. It presents as a slowly progressive myelopathy and necessitates surgical treatment. Herein, we describe a case of idiopathic spinal cord herniation treated with the hammock method. The patient was a 63-year-old male who became aware of numbness in his left toe twelve months prior to his initial visit. At that time, he had difficulty standing on his right leg. Sensation for pain and temperature was decreased in the left half of his body below the navel. Bilateral lower extremity tendon reflexes were hyperactive, and the bilateral Babinski reflex was positive. He also reported a weak urine stream. The Japanese Orthopedic Association (JOA) score for the thoracic spine was 5 out of 11 . Magnetic resonance imaging (MRI) revealed a dural defect at the T4 level, with spinal cord extramedullary prolapse and anterior deviation. Computed tomography (CT) myelography revealed a dural defect in the same area. The patient presented with Frankel classification grade C paraplegia and a slowly progressive BrownSéquard syndrome. He was diagnosed with idiopathic spinal cord herniation. We performed dural patch closure using the hammock method. Transcranial electrically stimulated muscle evoked potentials and somatosensory evoked potentials were used for monitoring during surgery. After a laminectomy from T3 to T6, a mid-longitudinal incision was made through the dura and arachnoid to expose the spinal cord. The denticulate ligaments were dissected bilaterally, and the nerve roots were preserved. Due to severe adhesions, we expanded the cephalic defect. Next, we passed a non-powdered nitrile sheet anteriorly under the spinal cord, suspending it. The adhesions around the defect and the spinal cord were completely removed, and the spinal cord emerged. An expanded polytetrafluoroethylene (ePTFE) sheet was then inserted to replace the nitrile sheet and sutured to the dura mater as a full-perimeter patch to cover the defect. Postoperatively, there was no progression of paralysis, the anterior deviation of the spinal cord disappeared, and no recurrence was observed two years after surgery. Although he still needed a walking stick, his walking speed improved, and his sensory impairment improved. Final JOA score for the thoracic spine was 8 out of 11. Categories: Neurosurgery, Orthopedics Keywords: brown-séquard syndrome, dural patch closure, expanded polytetrafluoroethylene (eptfe) sheet, hammock method, idiopathic spinal herniation, kinking type, serious adhesions, sling technique Introduction Idiopathic spinal cord herniation has traditionally been considered a relatively rare disease. In recent years, the number of reported cases has increased due to improvements in diagnostic imaging techniques. Idiopathic spinal cord herniation presents with slowly progressive myelopathy that does not resolve spontaneously, making it an indication. The following surgical methods have been reported: (1) hiatal enlargeme

FAQs

What condition was diagnosed in this case report?

The patient was diagnosed with idiopathic spinal cord herniation associated with severe adhesions and a dural defect at the T4 level.

What imaging findings supported the diagnosis?

MRI showed a dural defect with spinal cord extramedullary prolapse and anterior deviation, and CT myelography confirmed a dural defect in the same area.

How was the surgical treatment performed and what were the outcomes?

The team performed dural patch closure using the hammock method after T3–T6 laminectomy, with evoked-potential monitoring. Postoperatively, paralysis did not progress, anterior deviation resolved, and no recurrence was observed two years later, with improved walking speed and sensory impairment.

Sep 30, 2026

Uploaded by Ophelia