Idiopathic Anterior Thoracic Cord Herniation: A Case Report

Introduction: Idiopathic spinal cord herniation (ISCH) is a rare condition characterized by the ventral displacement of the spinal cord through a dural defect, presenting with symptoms such as lower limb weakness, back pain, gait disturbances, and Brown-Séquard syndrome. Due to its slow progression, diagnosis is often delayed. This study reviews a case and the literature to enhance diagnostic and therapeutic approaches.

Methods: A 43-year-old male presented with progressive numbness, paraparesis, and gait disturbances over four months. MRI revealed a ventral spinal hernia at T2-T3. After T2-T3 laminectomy, hernia reduction, and duroplasty, partial symptom improvement was observed. A follow-up MRI five years later confirmed resolution of the hernia without anterior cord kinking.

Results: A literature review of 61 ISCH cases (30 men, 31 women; mean age 49.1 years) was conducted through PubMed, focusing on hernia location: anterior, anterolateral, and posterior. Most herniations were anterior, involving the T2-T10 segments, especially T4 and T8. Primary symptoms included lower limb weakness, back pain, gait disturbances, and Brown-Séquard syndrome. MRI was effective for diagnosis, showing ventral displacement, a "tent" shape, and obliteration of the anterior subarachnoid space. Differential diagnoses included arachnoid cysts, schwannomas, astrocytomas, and other extramedullary lesions. Surgical outcomes improved in 75% of cases, with intraoperative ultrasound aiding in displacement detection. Laminectomy with duroplasty was the preferred surgical approach, although enlarging the dural defect posed a risk of CSF leakage. Early intervention resulted in improved function and lower recurrence rates.

Conclusion : Early identification of ISCH is crucial for better clinical outcomes. This review provides valuable insights into the diagnosis and management of ISCH, particularly through laminectomy and duroplasty, which improves patient outcomes.