the herniation can be classified into spontaneous , post - traumatic , and iatrogenic herniations . only four cases of post - traumatic cord herniation into pseudomeningocele after nerve root avulsion injury have been reported in literature . in all cases , spinal cord herniations are best visualized on computed tomography ( ct ) myelography or magnetic resonance imaging ( mri ) . we used a three dimensional ( 3-d ) turbo spin echo sequence sampling perfection with application optimized contrasts using different flip angle evolution ( space ) in our patient that provided optimal visualization of the pseudomeningocele and the herniated cord . 3-d sequences such as space or constructive interference in steady - state ( ciss ) are non - invasive alternatives to ct myelography for visualization of spinal cord herniation . a 40-year - old male patient presented with history of progressive weakness of the right lower limb . four years back , he had sustained injuries in a road traffic accident and was admitted with head trauma . clinically , brachial plexus injury was suspected and nerve conduction studies suggested involvement of right c5d 1 nerve roots . four years later , the patient developed progressive weakness of the right lower limb and started walking with a limp . on examination , there was wasting and weakness of the right upper limb muscles . the power in the right hip and knee flexors was grade 4/5 medical research council ( mrc ) . mri of the patient was done on magnetom avanto 1.5 t mri ( siemens , erlangen , germany ) . axial , sagittal , and coronal t1- and t2-weighted images of the cervical spine were acquired , which revealed the presence of lateral pseudomeningoceles at c7d1and d1d2 levels [ figure 1 ] . dedicated 3-d space sequence and oblique coronal inversion recovery sequence of the right brachial plexus were also acquired . there was lateral herniation of a knuckle of cord into the pseudomeningocele at d1d2 neural foramen [ figures 2 and 3 ] . reconstruction of data set in any specified plane and superior spatial resolution of the 3-d sequence resulted in better appreciation of dura , dural defect , and the cord herniation . coronal reconstruction of space sequence showing post - traumatic pseudomeningocele at right c7-d1 and d1-d2 neural foramina ( white arrows ) coronal reconstruction of space sequence showing herniation of knuckle of cord into the pseudomeningocele ( white arrow ) . the dura is also well appreciated ( black arrow ) axial image of space sequence showing pseudomeningocele ( white arrow ) , cord herniation through dural defect ( black arrow ) and the dura ( black arrowhead ) due to progressive neurological deficit , a decision to treat the patient surgically was made . through a posterior approach the essential prerequisite for extradural spinal cord herniation is the presence of a dural defect . depending on the cause of this defect , cord herniations are classified as idiopathic , iatrogenic , and post - traumatic . idiopathic spinal cord herniation is a fairly well - defined entity occurring predominantly in middle - aged women , typically involving the thoracic cord . iatrogenic herniations have been reported secondary to failure of c1c2 wiring and pseudomeningocele formation secondary to surgery for cervical spine trauma and cervical spine degenerative disease . post - traumatic herniations have been noted secondary to nerve root avulsion , penetrating injury to the dura , and after vertebral fractures . in contrast to idiopathic herniation , diffuse myelopathy or unilateral pyramidal symptoms are the commoner presenting symptoms of post - traumatic spinal cord herniations . iatrogenic herniation presents with either myelopathy of myeloradiculopathy . our patient presented with progressive unilateral pyramidal symptoms . idiopathic herniations commonly occur in the dorsal cord through a ventral or venterolateral dural defect . most of the iatrogenic herniations have been reported in the cervical spine with a dorsal or dorsolateral direction of herniation . most of the post - traumatic cord herniations have been reported in the dorsal and lumbar spine , and the direction of herniation is either dorsal or dorsolateral . cord herniation into nerve root avulsion pseudomeningocele is a very rare subset of post - traumatic spinal cord herniation . only four such cases have been reported , three involving the lower cervical or upper dorsal cord and one involving the conus at upper lumbar level . dasilva et al . , reported the first such case , in a 40-year - old male . nineteen years after traumatic brachial plexus injury , the patient suffered brown - sequard syndrome , and herniation of cord into a pseudomeningocele arising from the right d1d2 intervertebral foramen was noted on imaging . yokota et al . , reported a 33-year - old patient presenting with brown - sequard syndrome 14 years after traumatic left brachial plexus injury . mri demonstrated herniation of the spinal cord into a large pseudomeningocele inside the c7d1 intervertebral foramen . in this patient , tanaka et al . , reported the case of a 22-year - old man presenting with a 2-year history of quadriplegia . imaging revealed lateral pseudomeningocele arising from the right c6c7 and c7d1 intervertebral foramen and cervical spinal cord herniation into this pseudomeningocele . ijiri et al . , reported a 72-year - old patient with spinal cord herniation associated with pseudomeningocele in the lower conus medullaris region , after nerve avulsion . ciss imaging showed the attachment of the spinal cord to the wall of a herniated pseudomeningocele and associated syringomyelia at the level of d12 . all the above cases presented with progressive neurological deficits years after the primary injury , which suggests that the herniation of cord was a progressive process . etiologically , it has been suggested that contact of cord with dural defect can lead to adhesion formation , and subsequently , cerebrospinal fluid ( csf ) pulsations could progressively squeeze a segment of the cord through the dural defect . radiologically , spinal cord kinking and neural tissue prolapse are observed in extradural cord herniations . spinal cord atrophy , cord signal change , and syrinx formation have been also observed . 3-d sequences such as space and ciss are especially useful due to superior spatial resolution and ability to reconstruct the dataset in any specified plane . we used 3-d space sequence with an excellent depiction of the dura , dural defect , and the herniated cord . the diagnostic information was adequate for surgical planning , and further evaluation by ct myelography was deemed unnecessary . we present a rare case of progressive neurological deficit due to cord herniation into post - traumatic pseudomeningocele , who was managed surgically and improved . 3-d t2-weighted sequence is a non - invasive alternative to ct myelography in the investigation of spinal cord herniation .