Thoracic cord ventral herniation through the dura defect

Thoracic cord ventral herniation through
the dura defect is an uncommon condition causing progressive myelopathy. Most
of the cases occur spontaneously, could be congenital or idiopathic. For some
patients there could be a history of previous thoracic surgery or trauma. The
dura defect usually needs repair to prevent progression of the myelopathy. The aim
of our report is to increase the clinical awareness of this condition
and highlight the importance of early diagnosis.

 

Case
report: A
33-year-old man presented with an insidious onset and progressive numbness over
right lower chest for about 2 years. He had a history of traffic accident and
underwent a repair of right knee tendon rupture 4 years before. In the past two
years, he also experienced intermittent mild to severe upper back pain,
sometimes radiating to the neck. The pain was aggravated by cough or a sudden changing
of position from lying to rising up. He got a scald burn over right calf due to
a reduction of thermal sensation on his right lower leg. The neurological examination
revealed right leg weakness with muscle strength of 4/5 and reduced pain and
temperature sensation below right chest (about T5 level). The vibration perception
was also decreased on right lower limb. The spinal magnetic resonance imaging
study showed a dura ventral herniation of spinal cord at the T3, 4 level. Due
to the symptomatic myelopathy, he underwent an operation of total laminectomy
of T2-5 with repair of ventral dura defect. After the surgical treatment, his back
pain relieved and however the numbness ameliorated little only.

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Conclusion: Symptomatic myelopathy is usually
due to compression of the spinal cord from degenerative disease, tumor, injury,
circulatory or inflammatory diseases. A ventral spinal cord herniation through
the dura defect is very rare. Most patients with such ventral cord herniation could
suffer from progressive myelopathy for many years before
the correct diagnosis is achieved. The awareness and
early diagnosis are essential to prevent irreversible neurological dysfunction.

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