A 66-year-old female farm worker presented with 7 years of progressive back pain and impaired motor and sphincter function. On neurological examination, she exhibited a sensory level at T4 with a spastic paraparesis and bilateral (right greater than left) muscle atrophy.[] The MR revealed a ventral dural gap at the T4 level [Figure –]. She underwent a T4 laminectomy at which time the ventral dural gap was repaired (e.g. ventral dura mater defect repaired utilizing a 5-0 prolene suture to attach a muscle/fascia patch to the surrounding healthy dura mater) and the cord was reduced [] at surgery. The herniated cord appeared “violaceous/pale” in color and was hardened []. Postoperatively, the patient showed improvement in muscle strength in the lower limbs, allowing her to walk with assistance (with a cane or walker).
A 67-year-old female presented with complains slowly progressing bilateral leg weakness with associated chronic low back pain. There was no bowel or bladder involvement. On examination, motor and sensory exams were normal. Lab work was unremarkable. Magnetic resonance imaging (MRI) was performed which demonstrated anterior displacement of the spinal cord with an associated kink at T6 level with cerebrospinal fluid (CSF) pulsation artifacts in the posterior subarachnoid space []. High-resolution thin slice T2-weighted imaging demonstrated subtle small focus of herniated cord through the dural defect []. The findings favored spinal cord herniation instead of a posterior arachnoid cyst. To confirm the findings, a CT myelogram was performed which showed anterior cord kink at T6 with complete opacification of CSF posterior to the kinked and anteriorly displaced spinal cord confirming spinal cord herniation and excluding arachnoid cyst [].