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Successful treatment of a patient with an extremely rare spinal cord herniation at East Hospital
Physicians at the Neurology and Neurosurgery Clinic of Riga East University Hospital (East Hospital) have successfully diagnosed and treated a patient with an extremely rare spinal cord herniation – a progressive neurological disorder reported only in a few hundred clinical cases worldwide. Following surgery, the patient is recovering well, is able to walk independently, and continues rehabilitation.
The complex diagnosis and treatment involved a multidisciplinary team comprised of East Hospital’s physicians, in cooperation with international experts and using intraoperative neuromonitoring during a high-complexity neurosurgical procedure. This case demonstrates the critical importance of a multidisciplinary team and expertise in the treatment of rare and complex conditions.
The patient presented to East Hospital with complaints of progressive weakness in the right leg and gait disturbance over the past year. According to neurologist Rūta Ozoliņa, Head of the Day Hospital at the Neurology and Diagnostics Unit within the Neurology and Neurosurgery Clinic, the initial examinations revealed a lesion of the thoracic spinal cord. However, establishing an accurate diagnosis proved particularly challenging.
During the diagnostic clarification process, the medical staff consulted Dr. med. Juris Jansons, Head of the Spine Surgery Department at Helios Klinikum Aue (Germany), neurosurgical experts at Helios Klinikum Berlin-Buch (Germany), and specialists from Inselspital, Bern University Hospital (Switzerland).
“The patient underwent several diagnostic examinations during the assessment, such as laboratory tests, MRI, cerebrospinal fluid analysis, and later spinal myelography. Only through multidisciplinary collaboration with radiologists and neuroradiologists was it concluded that the patient had a very rare dural pathology, resulting in spinal cord herniation through a meningeal defect,” explains Rūta Ozoliņa.
In the event of such a pathology, the spinal cord is mechanically compressed or stretched, possibly leading to irreversible motor and sensory impairment as the disease progresses. Without treatment, the patient faced a high risk of disability. A review of the available medical literature and international clinical reports revealed that only around 128–200 such cases have been reported worldwide and that only some patients have undergone surgery. Accordingly, clinical experience in treating this condition remains extremely limited.
Neurosurgeon Dmitrijs Gavriļins from the Neurology and Neurosurgery Clinic emphasises that an accurate diagnosis was already a significant achievement in itself, but an even greater challenge was deciding on the appropriate treatment strategy.
“It was clear that, as the disease progressed, the patient would inevitably become disabled. At the same time, this surgery carried significant risks, given the extremely limited global experience in treating such patients. We analysed the available case literature and consulted Professor Claudius Thomé, Head of Neurosurgery at the University of Innsbruck (Austria), who had experience with a similar case. He confirmed and supported the planned operative approach, which gave us additional reassurance that the chosen treatment strategy was appropriate,” says Dmitrijs Gavriļins.
The neurosurgical team performed microsurgical release of the entrapped spinal cord from surrounding tissues, repositioned it into its anatomically correct location, and closed the dural defect. The surgery was performed under a microscope with high magnification, using high-precision instruments.
Intraoperative neuromonitoring was of particular importance. Neurophysiologist Vlada Meļņikova from the Neurology and Neurosurgery Clinic points out: “We monitored neural impulse conduction on a continuous basis to make sure that the surgical procedure did not result in additional damage to the spinal cord. If we detected a potentially dangerous response, the neurosurgeons could immediately adjust their technique or change the course of procedure. Until now, we could only assess possible consequences after surgery, once the patient had woken up, but now intraoperative neuromonitoring allows for a much safer decision-making during the surgery.”
Professor Guntis Karelis, Head of the Neurology and Neurosurgery Clinic, explains that spinal cord herniation is one of the rarest neurological conditions, and its diagnosis is often challenging, as symptoms may resemble those of other spinal or neurological conditions. Timely diagnosis and a multidisciplinary approach are therefore critically important, as untreated spinal cord compression may result in irreversible neurological damage.
The surgical planning and procedure involved specialists in neurology, neurosurgery, radiology, neurophysiology, and anaesthesiology, ensuring comprehensive multidisciplinary care throughout all stages. The team included neurologist Rūta Ozoliņa, neurosurgeon Dmitrijs Gavriļins, neurophysiologist Vlada Meļņikova, radiologist Artūrs Šilovs, radiologist Līga Jaunozoliņa, physician assistant Evelīna Kočāne, surgical nurse Karīna Teleženko, anaesthesiologist Anita Skudre, resident physician Sabīne Jablonska, and anaesthesia nurse Natālija Kruste.
The patient is currently undergoing rehabilitation and remains under medical supervision. Physicians consider the postoperative outcome to be very good and expect further improvement in her overall condition.
About the East Hospital
Riga East University Hospital is the largest and strategically significant multi-profile hospital in the country. The hospital consists of five inpatient facilities – Gaiļezers, Latvian Oncology Centre, Biķernieki, Tuberculosis and Lung Disease Centre, and Latvian Infectious Diseases Centre, along with various specialised centres and clinics. The hospital provides highly specialised inpatient and secondary outpatient healthcare, offering multidisciplinary tertiary-level treatment and care in line with modern technology and medical knowledge. Approximately 80% of all cancer patients in Latvia are treated at the hospital. It serves as a practical training base for both Latvian educational institutions and foreign students, providing further education and knowledge transfer to healthcare specialists within and beyond the country. The hospital engages in scientific research and develops innovative methods for patient treatment. As the third-largest employer in the country, the hospital employs around 5000 staff members.
