715 Outcome of Surgically and Conservatively Managed Spinal Cord Herniation

Aim Spinal Cord Hernia (SCH) is a rare cause of progressive myelopathy and pain relating to protrusion of the cord through a dural defect. We describe the characteristics and outcomes of surgically and conservatively managed patients treated at our institution. Method A retrospective case review of patients treated from 2005 to 2021 was conducted and combined with contemporary telephone follow-up using objective measures of disability and pain (the Spinal Cord Independence Measure and Numerical Analogue Pain Scale). Results 42 patients were included in our review (mean age 52.4 years; SD = 15.1 years). The mean time from symptom onset to diagnosis was 3 years (SD = 5.43 years). 64% of patients were female, and 88% had a neurological deficit at presentation. Surgery was performed in 52.3% of patients. Brown-Séquard syndrome at presentation was a predictor of receiving surgical management. Patients treated surgically were more likely to develop postoperative paraesthesia, weakness, and sphincter abnormalities. We acquired contemporary telephone follow-up in 64% of patients. Spinal Cord Independence Measure scores in the surgically and conservatively treated patients were equivocal at 82.6/100 and 85.1/100 respectively (95% CI [17.360, -22.493]; p = 0.396). Conclusions Patients with spinal cord hernia face a prolonged period between symptom onset and diagnosis. Minimally symptomatic patients can be managed conservatively, and many may improve or stabilise. Early post-operative weakness is common, but most patients remain independent and improve beyond or return to their pre-operative status.