Background: Symptomatic myelopathy is usually due tocompression of the spinal cord from degenerative disease, tumor, injury,circulatory, or inflammatory diseases. A ventral spinal cord herniation throughthe dura defect is very rare and could be remained unnoticed despite theprogression of the symptoms.
Most of the casesoccur spontaneously, could be congenital or idiopathic. For some patients therecould be a history of previous thoracic surgery or trauma. The dura defectusually needs repair to prevent progression of the myelopathy. Obejctive: To report a caseand review the literatures to increase the clinical awareness of this condition. 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. 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 the numbness ameliorated. Conclusion: Thoracic cordventral herniation through the dura defect is an uncommon condition causing progressivemyelopathy. Most of the patients with the ventral cord herniation could sufferfrom progressive myelopathy for many years before the correctdiagnosis is achieved. The clinical awareness and earlydiagnosis are essential to prevent irreversible neurological dysfunction.