Idiopathic thoracic spinal cord herniation

Case contributed by Jonathan Mancao

Presentation

Worsening chronic neck pain over the past 5+ years. Patient denies any history of a fall or other spinal trauma.

Patient Data

Age: 60 years
Gender: Female

Post-myelogram

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The subarachnoid space is opacified with contrast. Ventral tethering/positioning of the flattened thoracic spinal cord at the T2-T3 level. A well-definite focal protrusion of the cord through the dura is not visualized.  Mild anterolisthesis of T2 on T3 noted.  

On axial images, there is a central disc bulge at T6-T7 and a left paracentral disc bulge at T7-T8 with minimal indentation on the thecal sac. No significant spinal canal or neural foraminal stenosis is seen. The spinal canal and neural foramina are otherwise patent at the remaining levels.  

Mildly decreased caliber, ventral displacement, and subtle increased T2 signal of the thoracic spinal cord at the level of T2-T3, which may be seen in the setting of idiopathic spinal cord herniation. Partial visualization of a tiny syrinx extending inferiorly to the level of T2.

Case Discussion

Findings are suspicious for thoracic spinal cord herniation with ventral displacement/deformation of the cord through a potential anterior dural defect. Spinal cord herniations more commonly occur in females than in males (3:2), and Brown-Sequard syndrome is a classic presentation. This patient was referred to neurosurgery for further management. Differential diagnosis includes a dorsal arachnoid cyst.

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