Ventral thoracic spinal cord herniation: illustrative case

BACKGROUND Idiopathic spinal cord herniation (ISCH) is a rather uncommon pathology in which the spinal cord herniates through a dural defect, which can lead to severe neurological disability. OBSERVATIONS Here we present the case of a 47-year-old female with 2 years of right lower extremity pain with progression to right lower extremity contractures with classic thoracic myelopathy. Spinal MRI revealed a ventral dural defect with spinal cord herniation at T7 and associated ventral epidural fluid collection spanning from T1 to T9. She underwent a T6–8 instrumented posterior spinal fusion with T7 laminectomy, facetectomies, and a right-sided T7 transpedicular approach followed by microsurgical reduction of herniated spinal cord followed by a dual bolstered repair of the ventral dural defect. LESSONS ISCH is a rare cause of progressive myelopathy with a paucity of literature surrounding its treatment. Our case presentation, operative illustration, and discussion highlight key diagnostic and operative considerations with the surgical goal of safely detethering the cord and implementing adjuvant measures to reduce the risk for reherniation and progressive neurological decline. https://thejns.org/doi/10.3171/CASE26420