Thoracic cord herniation through a dural defect: description of a case and review of the literature.

Background: Spinal cord herniation through a dural defect is a cause of myelopathy and BSS that may be underdiagnosed. It may occur spontaneously, after trauma, or after surgery. Case Description: We present the case of a 47-year-old woman who presented with low back pain, progressive myelopathy, right proximal LEW, several episodes of falling, sensory changes below the lower part of the chest wall, and pathologic reflexes. Magnetic resonance imaging of the thoracic spine showed kinking of the spinal cord anteriorly at the level of T6-7. Posterior laminoplasty and intradural exploration revealed an anteriorly displaced spinal cord that was herniating through a ventral dural fold. The defect was repaired, and the spinal cord abnormality was reduced. Postoperatively, the patient's strength, gait, and sensation improved immediately. Conclusions: We discuss the successful surgical treatment of a thoracic spinal cord tethering from herniation through a ventral dural defect and review the literature regarding the proposed pathogenesis, surgical repair options, and reported outcomes. (c) 2009 Elsevier Inc. All rights reserved.