Teaching NeuroImages: Spinal cord herniation after cervical corpectomy

A 48-year-old man presented with worsening generalized pain. He had a history of complex cervical deformity and C2-T4 anterior and posterior instrumented fusions. On neurologic examination, cranial nerves, sensation, and strength were intact. Imaging demonstrated herniation of the spinal cord into the corpectomy defect and myelomalacia of the herniated cord (figure). Components of the patient's pain were attributed to myelomalacia. Spinal cord herniation (SCH), when iatrogenic, mostly occurs in the setting of posterior instrumentation and associated pseudomeningocele formation. SCH may also develop as a complication of anterior cervical decompression and underlying dural defect is the most likely mechanism.^1,2

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