Thoracic sensation below right chest (about T5 level).

Thoracic cord ventral herniation through the dura defect is an uncommoncondition causing progressive myelopathy. Most of the cases occur spontaneously,could be congenital or idiopathic. For some patients there could be a historyof previous thoracic surgery or trauma.

The dura defect usually needs repair toprevent progression of the myelopathy. The aim of our report is to increase theclinical awareness of this condition and highlight the importance ofearly diagnosis. Casereport: A33-year-old man presented with an insidious onset and progressive numbness overright lower chest for about 2 years. He had a history of traffic accident andunderwent a repair of right knee tendon rupture 4 years before. In the past twoyears, he also experienced intermittent mild to severe upper back pain,sometimes radiating to the neck.

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The pain was aggravated by cough or a sudden changingof position from lying to rising up. He got a scald burn over right calf due toa reduction of thermal sensation on his right lower leg. The neurological examinationrevealed right leg weakness with muscle strength of 4/5 and reduced pain andtemperature sensation below right chest (about T5 level). The vibration perceptionwas also decreased on right lower limb.

The spinal magnetic resonance imagingstudy showed a dura ventral herniation of spinal cord at the T3, 4 level. Dueto the symptomatic myelopathy, he underwent an operation of total laminectomyof T2-5 with repair of ventral dura defect. After the surgical treatment, his backpain relieved and however the numbness ameliorated little only.  Conclusion: Symptomatic myelopathy is usuallydue to compression of the spinal cord from degenerative disease, tumor, injury,circulatory, inflammatory diseases. A ventral spinal cord herniation throughthe dura defect is very rare that the condition could be remained unnoticed despitethe progression of the symptoms. Most of the patients with the ventral cordherniation could suffer from progressive myelopathy for many years before the correct diagnosis isachieved. The clinical awareness and early diagnosis are essential to prevent irreversibleneurological dysfunction.


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