# A successful surgical management of spinal cord herniation in a patient with old thoracic spine fracture: a case report from Syria

## TL;DR

A Syrian man with a rare spinal cord herniation at T5 level successfully underwent surgery, showing improvement and no recurrence after nine months.

## Contribution

This is the first reported case of idiopathic spinal cord herniation in Syria and the 250th globally, highlighting trauma as a cause and surgical suture therapy as effective.

## Key findings

- Surgical repair of the ventral dura tear led to improvement in lower-extremity weakness with no recurrence after nine months.
- Trauma is identified as a leading cause of spinal cord herniation, with surgical intervention preventing deterioration.
- A longer surgical incision and facetectomy on the most affected side are recommended for better surgical access and outcomes.

## Abstract

Idiopathic spinal cord herniation is a very uncommon condition marked by the spinal cord protruding through a defect in the front part of the dura mater. Because there is limited clinical evidence available, the treatment options and outcomes for idiopathic spinal cord herniation remain unclear. We report this first case of idiopathic spinal cord herniation at the T5 level in Syria.

A 31-year-old Syrian man presented with a 4-year history of numbness and weakness in the right lower limb. Magnetic resonance imaging (MRI) revealed that his spinal cord was displaced ventrally at the T5 level. A surgical procedure was performed through a posterior midline approach. During the operation, a tear in the ventral dura was discovered. After the herniated tissue was repositioned, the defect was closed with sutures. After a 3-month follow-up, the lower-extremity weakness was improved, and there was no recurrence. The patient remained stable after nine months.

Spinal cord herniation is a rare and challenging condition for medical practitioners because it is poorly understood. Several pathological mechanisms have been proposed, yet the term “idiopathic spinal cord herniation” remains the most common. Trauma and mechanical mechanisms are more convincing and generally accepted.

Surgery's main goal is to prevent the worsening of the condition, we identify trauma as a key cause and highlight suture therapy as an effective treatment. More studies are needed to clarify the pathology and treatment options for this disease.

•This is the 250th documented spinal cord herniation case in the medical literature and the first in Syria.•Traumas are the leading cause of spinal cord herniation.•Surgery is necessary to prevent the condition from deteriorating. The longer the surgical incision, the easier the surgery.•We recommend facetectomy on the most affected side to provide a better surgical view.

This is the 250th documented spinal cord herniation case in the medical literature and the first in Syria.

Traumas are the leading cause of spinal cord herniation.

Surgery is necessary to prevent the condition from deteriorating. The longer the surgical incision, the easier the surgery.

We recommend facetectomy on the most affected side to provide a better surgical view.