{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:23:19Z","timestamp":1794324199300,"version":"4.9.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:p>Spontaneous intracranial hypotension (SIH) has been increasingly reported in the literature concomitant with the improved sensitivity of imaging modalities. Although typically associated with meningeal weakening, a handful of cases of SIH secondary to thoracic disc osteophytes have been reported. Five of 7 reported cases were treated with epidural blood patch (EBP) alone while 2 required surgical management. There is no standard operative approach; both anterior and posterolateral approaches can be cumbersome and associated with morbidity, particularly in young, healthy patients. The authors report a case of SIH in which a ventral dural tear secondary to a calcified thoracic disc was repaired via posterior thoracic laminoplasty with dorsal durotomy and intradural exposure of the ventral defect with transdural discectomy followed by primary closure.<\/jats:p>\n                  <jats:p>A 34-year-old man presented with low-pressure headaches following axial load injury from a ski accident 5 years earlier. The patient's symptoms were refractory to a trial of conservative treatment and EBP, and he developed bilateral upper-extremity paresthesias. MRI of the spine demonstrated an extrathecal collection spanning the thoracic spine, and dynamic CT myelography identified contrast extravasation adjacent to a calcified paramedian disc at T9\u201310. The patient underwent posterior laminoplasty with neuromonitoring. A ventral dural defect was visualized via a dorsal durotomy, the penetrating disc osteophyte was removed transdurally, and the ventral and dorsal dura maters were closed primarily. Both somatosensory and motor evoked potentials were unchanged during surgery. The patient has remained asymptomatic more than 10 months postoperatively and he has resumed work as a surgeon.<\/jats:p>\n                  <jats:p>Cases of SIH secondary to a calcified thoracic disc are rare with little precedent as to optimal surgical intervention. This case illustrates the potential usefulness of posterior laminectomy in nonmyelopathic patients in whom there is no evidence of canal compromise and for whom neuromonitoring is available. Additionally, surgeon experience and patient preference may guide surgical planning.<\/jats:p>","DOI":"10.3171\/2014.10.spine14439","type":"journal-article","created":{"date-parts":[[2015,2,6]],"date-time":"2015-02-06T10:02:12Z","timestamp":1423216932000},"page":"478-482","source":"Crossref","is-referenced-by-count":9,"title":["Posterior thoracic laminoplasty with dorsal, intradural identification of ventral defect and transdural discectomy for a spontaneous cerebrospinal fluid leak: case report"],"prefix":"10.3171","volume":"22","author":[{"given":"Katie","family":"Pricola Fehnel","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital; and"},{"name":"Vascular Biology Program and Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence F.","family":"Borges","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine14439","series-title":"Clin Imaging","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.clinimag.2012.11.006","article-title":"Spontaneous intracranial hypotension from calcified thoracic disc protrusions causing CSF leak successfully treated with targeted epidural blood patch","volume":"37","author":"Allmendinger","year":"2013"},{"key":"b2-spine14439","series-title":"Anesthesiology","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1097\/00000542-199610000-00029","article-title":"Lumbar and thoracic epidural blood injections to treat spontaneous intracranial hypotension","volume":"85","author":"Benzon","year":"1996"},{"key":"b3-spine14439","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"614","DOI":"10.3171\/spi.2005.2.5.0614","article-title":"Spontaneous intracranial hypotension associated with transdural thoracic osteophyte reversed by primary dural repair. Case report","volume":"2","author":"Binder","year":"2005"},{"key":"b4-spine14439","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"221","DOI":"10.3171\/2009.9.SPINE09476","article-title":"Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion","volume":"12","author":"Bransford","year":"2010"},{"key":"b5-spine14439","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1136\/jnnp.34.1.68","article-title":"Diagnosis and treatment of thoracic intervertebral disc protrusions","volume":"34","author":"Carson","year":"1971"},{"key":"b6-spine14439","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1007\/s00586-011-1990-4","article-title":"Posterior transdural discectomy: a new approach for the removal of a central thoracic disc herniation","volume":"21","author":"Coppes","year":"2012"},{"key":"b7-spine14439","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1212\/WNL.43.3_Part_1.609","article-title":"Dural enhancement and cerebral displacement secondary to intracranial hypotension","volume":"43","author":"Fishman","year":"1993"},{"key":"b8-spine14439","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"628","DOI":"10.3171\/jns.1976.45.6.0628","article-title":"Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine","volume":"45","author":"Larson","year":"1976"},{"key":"b9-spine14439","series-title":"AJNR Am J Neuroradiol","first-page":"1711","article-title":"Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks","volume":"24","author":"Luetmer","year":"2003"},{"key":"b10-spine14439","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"690","DOI":"10.3174\/ajnr.A2849","article-title":"When should I do dynamic CT myelography? Predicting fast spinal CSF leaks in patients with spontaneous intracranial hypotension","volume":"33","author":"Luetmer","year":"2012"},{"key":"b11-spine14439","series-title":"Ann Thorac Surg","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1016\/0003-4975(93)90966-L","article-title":"Application of thoracoscopy for diseases of the spine","volume":"56","author":"Mack","year":"1993"},{"key":"b12-spine14439","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1227\/00006123-199511000-00009","article-title":"Retropleural approach to the thoracic and thoracolumbar spine","volume":"37","author":"McCormick","year":"1995"},{"key":"b13-spine14439","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"912","DOI":"10.3171\/jns.1998.88.5.0912","article-title":"Spinal dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension. Report of three cases and review of the literature","volume":"88","author":"Moayeri","year":"1998"},{"key":"b14-spine14439","series-title":"Mayo Clin Proc","doi-asserted-by":"publisher","first-page":"400","DOI":"10.4065\/72.5.400","article-title":"Syndrome of orthostatic headaches and diffuse pachymeningeal gadolinium enhancement","volume":"72","author":"Mokri","year":"1997"},{"key":"b15-spine14439","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1007\/s00586-010-1294-0","article-title":"The transdural approach for thoracic disc herniations: a technical note","volume":"19","author":"Moon","year":"2010"},{"key":"b16-spine14439","series-title":"J Am Med Assoc","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1001\/jama.1955.02950300038008","article-title":"Intracranial hypotension secondary to lumbar nerve sleeve tear","volume":"157","author":"Nosik","year":"1955"},{"issue":"6","key":"b17-spine14439","series-title":"Neurosurg Focus","first-page":"ECP2","article-title":"Intracranial hypotension syndrome: a comprehensive review","volume":"15","author":"Paldino","year":"2003"},{"key":"b18-spine14439","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"768","DOI":"10.3171\/jns.1978.48.5.0768","article-title":"A surgical approach through the pedicle to protruded thoracic discs","volume":"48","author":"Patterson","year":"1978"},{"key":"b19-spine14439","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1212\/WNL.42.3.481","article-title":"Spontaneous intracranial hypotension: report of two cases and review of the literature","volume":"42","author":"Rando","year":"1992"},{"issue":"3 Suppl","key":"b20-spine14439","series-title":"J Neurosurg","first-page":"282","article-title":"Spontaneous intracranial hypotension from intradural thoracic disc herniation. Case report","volume":"98","author":"Rapport","year":"2003"},{"key":"b21-spine14439","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"598","DOI":"10.3171\/jns.1996.84.4.0598","article-title":"Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension","volume":"84","author":"Schievink","year":"1996"},{"key":"b22-spine14439","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"243","DOI":"10.3171\/jns.1998.88.2.0243","article-title":"Surgical treatment of spontaneous spinal cerebrospinal fluid leaks","volume":"88","author":"Schievink","year":"1998"},{"key":"b23-spine14439","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1212\/WNL.57.10.1921","article-title":"The efficacy of epidural blood patch in spontaneous CSF leaks","volume":"57","author":"Sencakova","year":"2001"},{"key":"b24-spine14439","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/0002-9610(84)90372-6","article-title":"A transsternal approach to the upper thoracic vertebrae","volume":"148","author":"Sundaresan","year":"1984"},{"key":"b25-spine14439","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"483","DOI":"10.3171\/jns.1998.89.3.0483","article-title":"Cervical bone spur presenting with spontaneous intracranial hypotension. Case report","volume":"89","author":"Vishteh","year":"1998"},{"key":"b26-spine14439","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1016\/j.jocn.2013.02.008","article-title":"Successful surgical treatment of intractable spontaneous intracranial hypotension due to a calcified thoracic disc prolapse","volume":"20","author":"Wilson","year":"2013"},{"issue":"3 Suppl","key":"b27-spine14439","series-title":"J Neurosurg","first-page":"343","article-title":"Spontaneous intracranial hypotension due to thoracic disc herniation. Case report","volume":"96","author":"Winter","year":"2002"},{"issue":"Suppl 4","key":"b28-spine14439","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S422","DOI":"10.1007\/s00586-011-1979-z","article-title":"Surgical treatment of spontaneous intracranial hypotension secondary to degenerative cervical spine pathology: a case report and literature review","volume":"21","author":"Witiw","year":"2012"},{"key":"b29-spine14439","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1097\/00007632-199703010-00011","article-title":"The natural history of asymptomatic thoracic disc herniations","volume":"22","author":"Wood","year":"1997"},{"key":"b30-spine14439","series-title":"Intern Med","doi-asserted-by":"publisher","first-page":"228","DOI":"10.2169\/internalmedicine.32.228","article-title":"Primary low cerebrospinal fluid pressure syndrome associated with galactorrhea","volume":"32","author":"Yamamoto","year":"1993"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/5\/article-p478.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/5\/article-p478.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/5\/article-p478.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T17:26:05Z","timestamp":1681579565000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/5\/article-p478.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":30,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2014.10.spine14439","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2015,5]]}}}