Thoracic sensation below right chest (about T5 level).

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Thoracic cord ventral herniation through the dura defect is an uncommon
condition causing progressive myelopathy. Most of the cases occur spontaneously,
could be congenital or idiopathic. For some patients there could be a history
of previous thoracic surgery or trauma. The dura defect usually needs repair to
prevent progression of the myelopathy. The aim of our report is to increase the
clinical awareness of this condition and highlight the importance of
early diagnosis.


report: A
33-year-old man presented with an insidious onset and progressive numbness over
right lower chest for about 2 years. He had a history of traffic accident and
underwent a repair of right knee tendon rupture 4 years before. In the past two
years, he also experienced intermittent mild to severe upper back pain,
sometimes radiating to the neck. The pain was aggravated by cough or a sudden changing
of position from lying to rising up. He got a scald burn over right calf due to
a reduction of thermal sensation on his right lower leg. The neurological examination
revealed right leg weakness with muscle strength of 4/5 and reduced pain and
temperature sensation below right chest (about T5 level). The vibration perception
was also decreased on right lower limb. The spinal magnetic resonance imaging
study showed a dura ventral herniation of spinal cord at the T3, 4 level. Due
to the symptomatic myelopathy, he underwent an operation of total laminectomy
of T2-5 with repair of ventral dura defect. After the surgical treatment, his back
pain relieved and however the numbness ameliorated little only.


Conclusion: Symptomatic myelopathy is usually
due to compression of the spinal cord from degenerative disease, tumor, injury,
circulatory, inflammatory diseases. A ventral spinal cord herniation through
the dura defect is very rare that the condition could be remained unnoticed despite
the progression of the symptoms. Most of the patients with the ventral cord
herniation could suffer from progressive myelopathy for many years before the correct diagnosis is
achieved. The clinical awareness and early diagnosis are essential to prevent irreversible
neurological dysfunction.

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