title: Surgical Management of a Patient With Thoracic Spinal Cord Herniation: Case Report.
abstract: BACKGROUND
  Thoracic spinal cord herniation (TSCH) is rare and likely underdiagnosed. It is characterized by ventral herniation of the spinal cord through a dural defect, effacement of the anterior subarachnoid space, and increased posterior subarachnoid space. We present here a case of TSCH diagnosed and surgically treated at Barrow Neurological Institute, along with supplemental intraoperative video.
  
  
  METHODS
  A 61-year-old man with a history of progressive myelopathy causing left lower-extremity weakness with associated numbness, impaired gait, foot drop, incontinence, and sexual impotence was referred without any previous treatment. Computed tomographic myelography and magnetic resonance imaging of the thoracic spine showed ventral spinal cord herniation at T3-T4. Neurological monitoring was recorded preoperatively and intraoperatively. The patient underwent left-sided posterolateral exploration via T3-T4 laminectomies and costotransversectomy for intradural cord release/detethering of the spinal cord with additional superior and inferior extension and repair of the dural defect. Arthrodesis was not considered necessary. After cord release, motor evoked potentials showed immediate improvement from baseline. Dural duplication was considered the cause of TSCH in this case. Total reduction of herniation was evident in postoperative images. The postoperative course was uneventful, and at the last follow-up, the patient had regained ambulation and sphincter control.
  
  
  CONCLUSIONS
  Anterior displacement of the thoracic spinal cord should elicit consideration of herniation to prevent misdiagnosis and inadequate surgery. Surgical cord release and enlargement of the dural defect are safe and associated with good clinical outcomes.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Martinez-del-Campo
authors.forename: Karam
authors.initials: K
authors.lastname: Moon
authors.forename: Samuel
authors.initials: S
authors.lastname: Kalb
authors.forename: Hector
authors.initials: H
authors.lastname: Soriano-Baron
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
mesh_terms: D019054:Evoked Potentials, Motor; D006547:Hernia / Q000473:pathology*; D059685:Herniorrhaphy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000473:pathology / Q000601:surgery*; D013346:Subarachnoid Space / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome