Ventral Spinal Cord Displacement as a Cause of Thoracic Myelopathy: A Case Series of Nine Patients with Special Consideration of Magnetic Resonance Imaging Findings

Purpose: To describe a series of patients with thoracic myelopathy (TM) resulting from ventral spinal cord displacement (VSCD) with special consideration of magnetic resonance imaging (MRI) findings. Materials and Methods: Retrospective analysis of patients with TM as a consequence of VSCD and consecutive surgery with regard to sex and age, neurological symptoms and, in particular, MRI findings. Results: Inclusion of nine patients (3 women, mean age 52 years [range 28-74]) from a 15-year period (2010-2025). Most of the patients (6/9 [67 %]) were initially symptomatic with Brown-Séquard syndrome. MRI findings demonstrated Th 5/6 as the most affected segment (33%). We found surgically confirmed herniation (78%) more frequent than adhesion (22%). A direct anatomical relationship between the maximum ventral displacement of the spinal cord and an intervertebral disc was found in most cases (89%). Other findings in MRI were duplication of the ventral dura in four patients (44%) and in one case longitudinally extensive syringohydromyelia (11%) as well as focal T2 hyperintensity (11%) and vertebral body fracture (11%). All cases with dural duplication on imaging were associated with cord herniation. Postsurgical improvement of symptoms was achieved in five of nine patients (56 %; range of follow-up period: 3-84 months). Conclusion: VSCD is a rare cause of TM. Ventral cord herniations and adhesions must be differentiated from intradural arachnoid cysts and arachnoid webs, among other conditions. High-resolution MRI allows detection of VSCD and, together with clinical symptoms, helps to determine the indication for surgical treatment. Dural duplication might be a reliable radiological sign of cord herniation on MRI. Key Points: · Ventral spinal cord displacement is a rare cause of thoracic myelopathy.. · Cord herniations and adhesions must be distinguished from arachnoid cysts and webs.. · MRI is the gold standard for diagnosing ventral spinal cord displacement.. · Dural duplication on MRI may be a radiological sign of cord herniation.. Citation Format: · Neumann A, Gliemroth J, Schramm P et al. Ventral Spinal Cord Displacement as a Cause of Thoracic Myelopathy: A Case Series of Nine Patients with Special Consideration of Magnetic Resonance Imaging Findings. Rofo 2026; DOI 10.1055/a-2810-5055.