Idiopathic thoracic spinal cord herniation into the vertebra progressing for 3 years

TL;DR

A man with a rare spinal condition experienced worsening symptoms over three years and required surgery to correct the issue.

Contribution

This case report highlights the progression and surgical management of idiopathic thoracic spinal cord herniation into the vertebra.

Findings

The patient's spinal cord herniation progressed over three years, leading to intravertebral cord herniation.

Surgical reduction of the herniated cord through laminectomies was successful and resulted in an uneventful recovery.

The case suggests that some ITSCHs can become complicated by intravertebral cord herniation.

Abstract

A 43-year-old, previously healthy man experienced a decreased sensation in the left lower extremity without preceding spinal trauma. At presentation, the patient exhibited slight motor weakness in the left lower extremity, in addition to decreased pain sensation below the ipsilateral T7. Spinal magnetic resonance imaging (MRI) revealed abnormal findings consistent with idiopathic thoracic spinal cord herniation (ITSCH) at the T5/6 level. Computed tomography (CT) revealed a small vertebral erosion at the lower T5. The patient's symptoms gradually progressed over the next 3 years. MRI revealed marked lateral elongation of the cord at the T5/6 and apparent intravertebral cord herniation. The patient underwent ITSCH reduction through T5-6 laminectomies. The herniated cord was vertically long with a bulbous rostral part. Successful ITSCH reduction was achieved and the patient's postoperative course was uneventful. ITSCH is a progressive pathology that requires prompt surgical reduction. Certain ITSCHs may be complicated by intravertebral cord herniation.

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