Background: Ventral cordherniation from dura defect is a rare cause of focal progressive myelopathy dueto the thoracic cord herniation through the dural defect.
In the majority ofcases it is spontaneous, and could be congenital or idiopathic. In somepatients there could be a history of previous trauma or surgery in the thoracicregion. The dura defect usually is treatable but often misdiagnosed the causeof myelopathy. Early diagnosis is important in order to treat the patientsbefore the myelopathy has become advanced.
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 and onraising up from bed suddenly. He got a scald burn over right calf due to areduction 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 wasalso decreased on right lower limb. The spinal magnetic resonance imaging studyshowed a dura ventral herniation of spinal cord at the T3,4 level.
Due to thesymptomatic myelopathy, he underwent an operation of total laminectomy of T2-5with repair of ventral dura defect. After the surgical treatment, his back painrelieved and the numbness ameliorated as well. Conclusion: Symptomatic myelopathy is usuallycaused by compression from degenerative disease, tumor, injury, circulatory orinflammatory diseases, idiopathic ventral spinal cord herniation is a rare cause of thoracic myelopathy. Most patients experienceprogressive myelopathy for many years before the exactdiagnosis is achieved. The awareness and earlydiagnosis are essential to prevent irreversible neurological dysfunction.