Journal of Back and Musculoskeletal Rehabilitation 26 (2013) 251–254 251 DOI 10.3233/BMR-130381 IOS Press Case Report Concomitance of cervical intramedullary traumatic neuroma and cervical cord herniation in a tetraplegic woman Hui-Yi Su a , Yung-Tsan Wu a , Ming-Ying Liu b , Yu-Chun Lin c , Heng-Yi Chu a and Shin-Tsu Chang a,∗ a Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan b Department of Neurological Surgery, Tri-Service General Hospital, Taipei, Taiwan c Department of Pathology, Tri-Service General Hospital, Taipei, Taiwan Abstract. We present the first case of concomitant intramedullary traumatic neuroma and spinal cord herniation. A 57-year-old woman injured her cervical spine with subluxation and cord compression at the C5–C6 level. After the operation, the patient received intensive rehabilitation for one year with well response. Unfortunately, she experienced weakness and progressive numbness extending to all the limbs later. Cervical magnetic resonance imaging revealed spinal cord herniation at the C5–C6 level and pathology proved intramedullary traumatic neuroma. After the second operation, the paresthesia over the trunk and limbs persisted, and the patient was nearly totally assisted in her activities of daily living. The intramedullary traumatic neuroma and spinal cord herniation are rare causes in patients with spinal cord dysfunction. The case presented here indicates the possibility of the coexisting conditions leading to progressive neurologic deficits in patients with old spinal cord injury. Keywords: Intramedullary traumatic neuroma, cervical cord herniation, spinal cord injury 1. Introduction Traumatic neuroma is observed mostly in the pe- ripheral nervous system, and is rarely described in the intramedullary spinal cord. In their review of studies from 1931 to 1996, Melancia et al. [1] found only 37 cases of intramedullary neuroma, which were identi- fied by incidental autopsy, and all of them were asso- ciated with prior trauma, cervical spondylosis, multi- ple sclerosis, spinal tumor, or syringomyelia. Among * Corresponding author: Dr. Shin-Tsu Chang, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospi- tal, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan. Tel.: +886 2 8792 3311; Fax: +886 945 60 5523; E-mail: stchang@ms87.url.com.tw. them, Santagata et al. [2] reported the case of one liv- ing patient. The incidence of spinal cord herniation is low: there are only 100 reported cases of this condition [3], 10 of which resulted from trauma. Besides, most of those lesions were located at the thoracic level. Here, we present a case of concomitant intramedullary traumatic neuroma and spinal cord herniation at an old surgical site one year after previous cervical cord injury. 2. Case history Subsequent to a fall in October 2008, a 57-year- old woman injured her cervical spine and experienced muscle weakness and sensory loss thereafter. Motor power of the bilateral extremities was 2/5 for the arms ISSN 1053-8127/13/$27.50 c  2013 – IOS Press and the authors. All rights reserved