Presentation
Case of neck pain. No trauma/surgical history.
Patient Data
Focal ventral displacement of the thoracic cord at D7-D8 level, abutting the anterior thecal without ventral herniation of cord giving typical scalpel sign.
Compression of the cord was noted at the level of lesion; however, no abnormal cord signal was noted.
Posterior CSF space appears focally enlarged with preserved normal CSF flow artifact without abnormal cord signal within — possibilities of dorsal thoracic arachnoid web or dorsal arachnoid cyst to be considered.
Degenerative changes in the rest of the spine.
Focal ventral displacement with enlargement of the posterior thecal space giving a typical "scalpel sign" in the thoracic spine.
Case Discussion
This is an incidentally detected dorsal thoracic web/cyst. Two pathologies - dorsal arachnoid web and cyst - show similar features on MRI scans, and need evaluation with myelography to differentiate.
Conservative treatment is considered in asymptomatic cases. Neurosurgical intervention required in cases myelomalacia changes in the cord.
The most important diagnosis that needs to be ruled out is ventral cord herniation - which shows complete effacement of anterior thecal space with evidence of cord herniation.
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