Intradural Lumbar Disc Herniation Research Articles

Intradural lumbar disc herniation at the L3–L4 level: A case report and literature review

Abstract Only 0.26% of all disc herniations are caused by intradural disc herniation (IDH), making it a rare pathology. We present the case of a 44-year-old man who suffered from right radicular low back pain and motor impairments. At the level of L3–L4, magnetic resonance imaging (MRI) revealed an intradural, extra-axial spinal mass. This individual had several specific MRI imaging characteristics. Laminectomy, durotomy, and transforaminal lumbar interbody fusion surgery was performed, and the disc was completely removed. At the 6-month follow-up, the patient showed full recovery. The diagnosis of IDH is very challenging and every spine surgeon must be aware. The best treatment for this pathology is surgical intervention.

Intradural Lumbar Disc Herniation: Updated Report of a Case with Literature Review

Intradural lumbar disc herniation is a rare complication of disc disease. The mechanism by which a herniated disc tears the dura matter remains unknown. The preoperative diagnosis of an intradural lumbar disc herniation is still difficult. We report our experience dealing with a case of intradural lumbar disc herniation at level L3/4 in a 34-year-old man. Based on current experience, we found that attachment of the ventral dura to the posterior longitudinal ligament can be a favorable factor indicating intradural lumbar disc herniation. One should pay attention to those with cauda equina syndrome, as it can thereby promptly suggest a preoperative diagnosis of intradural lumbar disc herniation. Surgeons need to avoid omitting intraoperative lesions by palpating the dura mater during surgery for suspected tumor cases.

Potential Pathogenesis, Diagnostic MRI, and Surgical Findings of Intradural Lumbar Disc Herniation: A Report of Two Cases

Potential Pathogenesis, Diagnostic MRI, and Surgical Findings of Intradural Lumbar Disc Herniation: A Report of Two Cases

Concealed Intradural Disc Herniation: A Case Report

Introduction: We present a case of a concealed intradural lumbar disc herniation following a previous discectomy with adhesions of the ventral dura to the posterior longitudinal ligament. Case Presentation: A 40-year-old Asian male with a lumbar discectomy 2 years ago presented to our emergency department with over the last few days rapidly progressing neurological symptoms of the lower limbs. The patient was admitted and MRI was performed on an emergency basis. Due to severe pain, and as a result the patient inability to lie down to complete the MRI examination, the MRI scan was incomplete. However, it showed an occupying mass at the level L4/5 with suspected recurrent disc herniation. Intraoperative only a small herniation was found. A new MRI, performed shortly after the 1st surgery, revealed an intradural herniation that could be addressed by microscopic durotomy and sequestrectomy. Because of persisting weakness and pain a new MRI scan was done and revealed a recurrent intradural hernia proximal to the durotomy. Revision surgery was indicated and performed successfully. The 6 months follow-up MRI scan revealed no signs of recurrence. The clinical examination, 6 months postoperatively, showed almost complete remission of the preoperative weakness and pain with restoration of the walking ability. Discussion: Most literature addressing the pathophysiology of intradural lumbar disc herniation are cadaveric studies. Currently only few case reports or series discuss this pathology. Different theories including ‘mechanical compression’ and ‘adhesions’ theories have been discussed. A solid proof couldn’t be provided. Our patient had a previous discectomy at the same segment two years ago. The MRI scans could clearly show scar tissue on this level with a direct connection of the lumbar disc to the intradural compartment. We believe that extradural adhesions provided an access, through which disc fragments could migrate intradurally. Conclusion: Intradural disc herniation is a rare presentation and its diagnosis can be challenging. With rapidly progressing neurological symptoms and positive history for previous spinal surgery, intradural disc herniation should be kept in mind as an important differential diagnosis. Careful postoperative monitoring, and possibly early follow-up MRI, is needed to avoid missing a recurrent herniation or missed intradural disc fragments.

The importance of opening and probing the dura matter during surgery for intradural lumbar disc herniation with cauda equina syndrome: a case report

BackgroundIntradural lumbar disc herniation (ILDH), first reported in 1942, was a rare pathological type. Enhanced magnetic resonance imaging (MRI) is the “gold standard” for ILDH diagnosis but is rarely used for routine diagnosis of lumbar disc disease. Definite diagnosis often occurs intraoperatively.Case presentationA patient (52‐year‐old, man) was enrolled in the Affiliated Hospital of Zunyi Medical University admitted because of “low back pain with numbness and radiating pain in the left lower extremity for 5 years, with aggravation for 1 month and urinary incontinence for 6 days”. The patient was diagnosed with intradural lumbar disc herniation‐induced cauda equina syndrome at the L4‐5 vertebrae. Other diagnoses, such as epidural hematoma, arachnoiditis, abscesses, and tumors, were deemed unlikely. During the patient underwent emergency lumbar decompression, the potential presence of intradural disc herniation was found when we performed the open discectomy. So, if no significant disc is found outside the dura matter, consideration should be given to open and prob the dura matter. But previous studies haven't made it clear what to do about it. In this way, one day after surgery, the pain in the lower extremities was significantly relieved. Follow‐up 2 years after the operation showed that the clinical effect of the treatment scheme was significant.ConclusionThe report of this case was to provide reference images and a clinical basis for the diagnosis, treatment, and prognosis of ILDH.

Intradural lumbar disc herniation after full-endoscopic lumbar discectomy using the interlaminar approach: case report

Intradural lumbar disc herniation after full-endoscopic lumbar discectomy using the interlaminar approach: case report

Intradural lumbar disc herniations associated with cauda equina syndrome: report of two cases and review of literature

Intradural lumbar disc herniations associated with cauda equina syndrome: report of two cases and review of literature

Intradural Lumbar Disc Herniation: Report of Two Cases and Review of the Literature

Intradural Lumbar Disc Herniation: Report of Two Cases and Review of the Literature

An intradural lumbar disc fragment with free migration: A case of a missed intradural disc herniation

Abstract Introduction Intradural lumbar disc herniation (ILDH) is a very rare pathological entity. The pathomechanisms and the natural course remain unclear. Case presentation The authors present the case of a 58-year-old Germans male with repetitive microdiscectomies (MD) and intraoperative missed diagnosis of ILDH. The patient underwent standard MD due to lumbar disc herniation (LDH) at the level L4/5. Incidental durotomy (ID) was sealed with a ventromedial patch. Postoperative course was uneventful. 14 months later the patient presented with a L4 radiculopathy, having his second MD at the level L3/4. At this point the radiological images showed already a free floating intradural fragment at the level S1, clinically not significant. As in the previous surgery, the postoperative course was uneventful. After 18 months, he presented again complaining of low back pain and electric-like attacks of pain along the right L5 root for the prior five months. Contrast-MRI revealed that the known intradural disc-mass migrated from S1 to the level L4/5. A left L4 hemilaminectomy was performed. The durotomy identified a hard, white, shiny mass. The patient was pain-free until the last follow-up at 13 months. Conclusions Intraoperative manipulation of disc fragments in the presence of an ID potentially leads to iatrogenic ILDH.

Intradural Lumbar Disc Herniation Associated with HIV Infection

Intradural Lumbar disc herniation (IDLDH) is a known rare subgroup, accounting for 0.3% of all disc herniation. The incidence of IDDHs in 50-60 year olds is 2.2%, while that of 40-50 is only 0.2%. Most cases of reported intradural disc herniation (IDDH) are in the lumbar spine (92%), especially at L4-5 level (55%) with some reports in the cervical (5%) and thoracic (3%) spine. Chronic disease process is postulated as a possible etiology of the condition in most of the cases. We present a case of IDLDH in a patient with HIV infection as a possible etiological factor.

Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation

Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH.

Multiple Intradural Disc Herniations Masquerading as Intradural Extramedullary Tumors: A Case Report and Review of the Literature.

Intradural disc herniation is a very rare condition, and multiple intradural disc herniations have not been reported to date. The latter may be confused with intradural extramedullary (IDEM) spinal tumors. Here, we report a case of multiple intradural disc herniations masquerading as multiple IDEM tumors and review the relevant literature. We retrospectively reviewed the patient's medical chart, reviewed the intraoperative microscopic findings, and reviewed of PubMed articles on intradural disc herniation. The masses considered to be IDEM tumors were confirmed to be multiple intradural disc herniations. A nonenhancing mass was found to have migrated along the intra-arachnoid space. Two enhancing masses could not migrate because of adhesion and showed peripheral neovascularization. We report an extremely rare case of multiple intradural lumbar disc herniations showing diverse enhancing patterns and masquerading as multiple IDEM tumors. In case of multiple enhancing IDEM masses suspected preoperatively, surgeons should consider the possibility of intradural disc herniation.

The "Crumble Disc Sign": A Specific MRI Sign of Intradural Lumbar Disc Herniation, Allowing a Preoperative Diagnosis.

Intradural disc herniation (IDH) is very rare. Most diagnoses were surgical but with the improvements in magnetic resonance imaging (MRI) it has become possible to preoperatively diagnose intradural migration of disc in some cases. We report a case with very specific imaging features in MRI, well correlated with the surgical findings.

Intradural Lumbar Disc Herniation Associated with Degenerative Spine Disease

The first case of lumbar intradural disc herniation was reported as early as 1942; since then more than 150 cases have been reported, mostly in the lumbar spine. Gadolinium-enhanced magnetic resonance image (MRI) is considered the “gold standard” for diagnosing this entity, although it is rarely performed routinely in lumbar disc disease and diagnosis is often made intra-operatively and in retrospect in regard to the imaging. A 63-year-old Italian man presented to the emergency department complaining of lower back pain, difficulty in walking, and in urination, with bilateral leg pain. On examination, he showed uneven gait, pain in the right thigh and leg with intact sphincter function. A magnetic resonance image of the lumbar spine showed a large mediolateral herniated disc at L3-L4, also the patient had a stenosis at the thoracic level at T11-T12 and T12-L1. The plan was to do an MRI with Gado however the patient went into retention and so was operated before the MRI with Gado. Results: Intraoperatively the pathology was first identified as a big cyst like structure, that as thought to be a synovial cyst, and then once it was opened it turned out to be an intradural extension of a herniated disc. Decompression was also done at the thoracic level and finally instrumentation was done from T10 to S1. Conclusion: Intradural lumbar disc herniations are a rare entity, most of the time the diagnosis is not made pre operatively, however once it is diagnosed intra-operatively, careful removal of the herniated material should be done to avoid damaging the rootlets, sometimes u have double pathologies that need to be addressed like in this patient where he had both lumbar and thoracic stenoses.

Intradural Lumbar Disc Herniation Associated With Degenerative Spine Disease and Rheumatoid Arthritis

A case report. To demonstrate a case of intradural lumbar disc herniation including imaging studies, intraoperative imaging, and an intraoperative video. The first case of lumbar intradural disc herniation was reported as early as 1942; since then more than 150 cases have been reported, mostly in the lumbar spine. Gadolinium-enhanced magnetic resonance image (MRI) is considered the "gold standard" for diagnosing this entity, although it is rarely performed routinely in lumbar disc disease and diagnosis is often made intraoperatively. A 70-year-old man presented to the emergency department as a referral complaining of lower back pain, loss of sensation in the right thigh, and difficulty walking. On examination, he showed uneven gait, right-sided foot drop (1/5), hypesthesias in the right inguinal area and ventral thigh, and a positive straight leg raise test on the right. Anal sphincter tone was within normal limits. A magnetic resonance image of the lumbar spine showed a large mediolateral herniated disc at L3-L4, with caudal displacement and unclear signal changes intradurally. Intraoperatively, the herniated disc was found upon opening the dural sac. Intradural disc herniations are a rare entity. The opening and inspection of the dural sack should be considered when the correct spinal level can be confirmed and insufficient herniated disc material can be visualized extradurally.

Letter to editor concerning: “Intradural lumbar disc herniation: report of five cases with literature review”

Dear Sir, We have a point we would like to make in reference to the article entitled “Intradural lumbar disc herniation: report of five cases with literature review”, published by Ducati et al. [1] in European Spine Journal. Our attention was drawn to the fact that this author made no reference to a number of studies previously published by us [2, 3] and other authors [4, 5] which mention the association of intradural herniations or cysts with gas within the spinal canal. Moreover, we had already advised in our previous study of the possible need for intradural exploration where the CT or MRI imaging studies show the existence of gas within the canal and the intraoperative findings do not explain the patient’s symptoms.

Answer to the Letter to the Editor of A. Hidalgo-Ovejero concerning “Intradural lumbar disc herniation: report of five cases with literature review” (by L. G. Ducati, M. V. Silva, M. M. Brandão, F. R. Romero, M. A. Zanini; Eur Spine J. doi:10.1007/s00586-012-2631-2)

Dept. of Neurology and Psychiatry Hospital das Clinicas da Faculdade de Medicina de Botucatu University of the State of Sao Paulo (UNESP), CEP 18618-970 Botucatu Sao Paulo

Traumatic Intradural Lumbar Disc Herniation without Bone Injury.

Intradural lumbar disc herniation is a rare disease. According to the reports of intradural lumbar disc herniations, most cases have developed as a chronic degenerative disc diseases. Traumatic intradural lumbar disc herniations are even rarer. A 52-year-old man visited our emergency center with numbness in his left calf and ankle after falling accident. Initial impression by radiologic findings was a spinal subdural hematoma at the L1 level. A follow up image two weeks later, however, did not demonstrate any interval change. The patient was decided to have an operation. In operative findings, a ruptured disc particle penetrating the ventral and dorsal dura was indentified after laminectomy. It was assumed to be a traumatic outcome not a degenerative change.

A case report of intradural lumbar disc herniation

A case report of intradural lumbar disc herniation

Intradural lumbar disc herniation: report of five cases with literature review

Intradural lumbar disc herniations are uncommon presentations of a relatively frequent pathology, representing less than 1% of all lumbar disc hernias. They show specific features concerning their clinical diagnosis, with a higher incidence of cauda equina syndrome, and their surgical treatment requires a transdural approach. In this article, we describe five cases of this pathology and review the literature as well as some considerations about the difficulties in the preoperative diagnostic issues and the surgical technique. We concluded that for intradural disc herniations the diagnosis is mainly intraoperative, and the surgical technique has some special aspects.