Intradural Disk Herniation Research Articles

Difficulties in Diagnosis and Operation Associated With Lumbar Intradural Disc Herniation: A Case Report

Intradural disk herniation (IDH) represents an uncommon instance of disk degeneration. The surgical treatment of IDH, preoperative, and intraoperative diagnosis are difficult. The present case report highlights difficult parts of diagnosis and surgery. A 44-year-old man presented with lower back pain radiating to his right leg. A disk protruding into the ventral dural sac and exhibiting the hawk-beak sign was discovered by MRI. The dorsal side was exposed and incised during L3/4 laminectomy, a puncture on the ventral side was detected, and subsequently, three fragments extending into the dura sac were discovered. The defect was corrected and completed internal fixing was done. Pathology identified it as nucleus pulposus tissue. At one-month follow-up, he was able to walk normally. An incredibly uncommon form of disc degeneration is lumbar IDH. MRI can assist in the diagnosis, however, surgical investigation and pathology are necessary for an accurate diagnosis.

Reliable Intraoperative Repair Nuances of Cerebrospinal Fluid Leak in Anterior Cervical Spine Surgery and Review of the Literature

Cerebrospinal fluid (CSF) leak during anterior cervical spine surgery can lead to complications, including wound breakdown, meningitis, headaches, need for lumbar drain, or additional surgery. These leaks can be difficult to manage given the limited field of view and lack of deep access. Herein, we describe 8 consecutive patients who underwent intraoperative repair of CSF leak, with no postoperative evidence of wound dehiscence or drainage. A retrospective review was performed on 8 cases where CSF leak was encountered during an anterior cervical spine surgery. Patients had ossification of the posterior longitudinal ligament, intradural disk herniation, or dural ectasia. Intraoperative repair was as follows. First, CSF was drained to low pressure, and durotomy was covered by dural substitute and sealant agent. Then the interbody graft used was manually undersized in the anteroposterior dimension to allow for expansion of the agents used. Anterior instrumentation was then performed. Finally, a wound drain was anchored to a biologic bag for shoulder level passive drainage. In all 8 cases, there were no cases of wound dehiscence or CSF leak using this strategy. Likewise, there was no evidence of cord compression or neurologic deficits. No meningitis or persistent headaches were reported, and there was no need for lumbar drain placement at any time postoperatively. Once durotomy is encountered during anterior spine surgery, draining the CSF to a low pressure followed by dural substitute with a sealing agent, followed by a smaller anteroposterior size graft is an effective strategy of preventing complications in an inescapable problem.

L2/L3 Intradural Disk Herniation Mimicking Spinal Cord Tumor: A Case Report and Review of the Literature

Intradural disk herniation (IDH) is a rare variant of a common spine problem which occurs most often at fourth and fifth lum bar (L4, L5) level but is rare at higher levels. It is often difficult to diagnose preoperatively and differentiate from other spinal lesions. We describe a case of IDH at L2, L3 level and review the pathogenesis, radiological findings and intraoperative findings of IDH with emphasis on early recognition of the entity. We also review the literature of reported cases of IDH at L3 and L4 level.