A 51-year-old female presented with a 3-year history of thoracic back pain. Her medical history included diabetes, rheumatoid arthritis, and Sjögren's syndrome. The pain, when severe, was associated with nausea and vomiting. The patient reported longstanding reduced sensation bilaterally, in the L5 and S1 distribution, secondary to chronic lumbar spondylosis. There was no change in her lower limb neurological symptoms, specifically, no radicular pain or sphincter disturbance. There was no history of spinal trauma. Upon clinical examination, there was mild mid-thoracic tenderness. Lower limb neurological examination was complicated by leg stiffness related to the Sjögren's syndrome. There was global mild weakness Medical Research Council (MRC) grade 4/5 in bilateral lower limbs, and reflexes were normal. There was reduced sensation in the L5 and S1 distribution, which was a longstanding finding. MRI of the thoracic spine demonstrated features consistent with ISCH. T2-weighted images showed anterior deviation and flattening of the spinal cord at the T7 vertebral body level, with a small ventral dural defect and mild cord herniation []. The patient was treated conservatively, and at 4-year follow-up, her neurological condition remained stable.
This 58-year-old female complained about temperature changes and hyperpathy in her left leg for the past 12 months. On the right side, the sensibility was different but not normal. The strength in her left leg was diminished. These complaints ascended over time, initially starting at the foot and developing further to the groin at the time of presentation.\nNeurological examination revealed only a paretic quadriceps femoris muscle on the left side. Vital sensibility was disturbed on the left side below T10. The plantar reflexes on both sides were indifferent.\nAn MRI revealed a herniation of the SC at T8 (Figure ).\nDuring surgery, a laminectomy on T8 and T7 was performed. The dentate ligaments were transected. While gently mobilizing the SC from the left to the right, a large defect in the ventral dura was observed. The same maneuver at the right side revealed a fixed SC with the defect. After transection of some adhesions, a tumor-like extension of the SC was seen (Figure ) and was finally mobilized completely intradurally. To prevent re-herniation, an artificial graft was gently placed in front of the SC covering the defect and fixated laterally to the dural sleeve. Throughout the entire surgery, MEPs, SSEPs, and D-waves were monitored. Changes were not noticed. Post-operatively, the patient did not notice any new complaints.