Ventral Spinal Cord Displacement After Single-Level Anterior Cervical Corpectomy: A Case Report
Bharat R Dave1, Saurabh S Kulkarni1, Ajay Krishnan2,3
1Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, IND.
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Spinal cord herniation is a rare condition characterized by protrusion of the spinal cord through a dural defect, typically associated with progressive neurological deficits. However, postoperative alterations at the ventral dural-cord interface may present as cord displacement without a demonstrable dural breach. We report the case of a 44-year-old woman who presented with progressive gait imbalance, neck pain, and right upper limb radiculopathy of four weeks' duration. Imaging suggested compressive cervical pathology, and the patient underwent anterior cervical corpectomy and stabilization. Postoperatively, the diagnosis of spinal tuberculosis was established based on GeneXpert (GeneXpert® System; Cepheid, Sunnyvale, CA, USA) testing and histopathological examination. Magnetic resonance imaging (MRI) demonstrated ventral displacement of the cervical spinal cord at the operated level without evidence of a definite dural defect. On postoperative day 2, the patient developed mild, new-onset right-hand grip weakness (Medical Research Council (MRC) grade 4/5 in the C7-T1 distribution), which remained non-progressive. In the absence of radiological evidence of true cord herniation and given the stable clinical course, conservative management was adopted along with initiation of anti-tubercular therapy. Serial follow-up imaging demonstrated progressive reappearance of ventral cerebrospinal fluid (CSF) signal anterior to the spinal cord, with resolution of ventral dural adhesions and associated inflammatory tissue. This radiological improvement correlated with clinical stabilization following anti-tubercular therapy and mechanical stabilization of the segment. This case highlights a potential intermediate entity in the spectrum of ventral spinal cord pathology in the setting of spinal tuberculosis and underscores the importance of distinguishing reversible cord displacement from true herniation to avoid unnecessary surgical intervention.
