Thoracic cord ventral herniation through the dura defect

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

 Casereport: A33-year-old man presented with an insidious onset and progressive numbness overright lower chest for about 2 years. He had a history of traffic accident andunderwent a repair of right knee tendon rupture 4 years before. In the past twoyears, he also experienced intermittent mild to severe upper back pain,sometimes radiating to the neck. The pain was aggravated by cough or a sudden changingof position from lying to rising up. He got a scald burn over right calf due toa reduction of thermal sensation on his right lower leg. The neurological examinationrevealed right leg weakness with muscle strength of 4/5 and reduced pain andtemperature sensation below right chest (about T5 level). The vibration perceptionwas also decreased on right lower limb.

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The spinal magnetic resonance imagingstudy showed a dura ventral herniation of spinal cord at the T3, 4 level. Dueto the symptomatic myelopathy, he underwent an operation of total laminectomyof T2-5 with repair of ventral dura defect. After the surgical treatment, his backpain relieved and however the numbness ameliorated little only.  Conclusion: Symptomatic myelopathy is usuallydue to compression of the spinal cord from degenerative disease, tumor, injury,circulatory or inflammatory diseases. A ventral spinal cord herniation throughthe dura defect is very rare. Most patients with such ventral cord herniation couldsuffer from progressive myelopathy for many years beforethe correct diagnosis is achieved. The awareness andearly diagnosis are essential to prevent irreversible neurological dysfunction.

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