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Primary germinomas in the spinal cord are very rare with only 15 cases published previously. In this case a 22-year-old woman with urinary incontinence, lumbago, and bilateral leg pain and weakness was found to have a solid tumor in the conus medullaris between the L1 and L2 vertebral bodies. Serum HCG was elevated without pregnancy. The pathological diagnosis was mixed germinoma and choriocarcinoma of the intramedullary spinal cord. She received craninospinal irradiation and three courses of chemotherapy and is currently asymptomatic with no evidence of recurrence and metastasis 22 months after surgery. To our knowledge, this is the first case report of a patient with a primary mixed germinoma and choriocarcinoma of the intramedullary spinal cord. The previous 15 cases of primary spinal cord germinoma have been reviewed for comparison.