Intradural Disc Herniation, an Infrequent Spine Disease, Case Report

Abstract

1.1. Introduction: Intradural disc herniation (IDH) is a rare disease that affects the spine, difficult to diagnose clinically and radiologically and easily mistaken with other types of disc herniations. In this article is presented the case of a patient diagnosed and treated with IDH and reported it to share the diagnostic process as well as treatment performed, so that we can contribute to the proper management of these patients. 1.2. Case Presentation: This is a 40-year-old woman, with no history of physical activities that overload her lumbar spine, who underwent L4-L5 discectomy at another hospital in 2021, evolving with progressive worsening of symptoms, mainly paresthesia and hypoesthesia in the territory of L4-L5-S1 and bilateral flexion and extension loss of strength of the feet, associated with lumbosciatic pain. She was then diagnosed in our hospital with IDH and underwent extensive posterior bone decompression, intramedullary decompression, dural injury repair, fixation, and lumbar arthrodesis with a pedicle screw. The postoperative period was uneventful, with significant improvement of symptoms in the outpatient follow-up. 1.3. Conclusions: Because it is a rare disease, IDH must be correctly diagnosed for its effective treatment, even so the therapy is a great challenge for the Spine Surgery team. Some alterations in the MRI should draw the attention of the medical team to this condition, such as the “Hawk-beak sign”, which is present in this description. Thus, according to the medical literature, bone and medullary decompression can lead to a good recovery of the patient and even reversal of eventual neurological deficits.