Challenges in intradural disc herniation diagnosis and surgery: A case report

Arifin, Muhamad Thohar; K, Novita Ikbar; Brilliantika, Surya Pratama; Bakhtiar, Yuriz; Bunyamin, Jacob; Muttaqin, Zainal

doi:10.1016/j.amsu.2020.08.022

Cited by 13 publications

(20 citation statements)

References 10 publications

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“…HDIs are often misdiagnosed, confused with other extra medullary intradural lesions such as schwannomas, neurofibromas, lipomas, meningiomas, squamous tumor, arachnoid cyst, ganglioneuroma or metastasis [2,8,9]. In this case, preoperative diagnostic doubts were raised, not ruling out the possibility of other intradural injuries.…”

Section: Discussionmentioning

confidence: 86%

“…Thick adhesions between the disc and the dura have been reported at the time of surgery while the dural sac tends to be rough, tight, and immobile. For these reasons, the microsurgical approach through a median or paramedian dural incision is recommended for better visualization of the hernia, avoiding damage to the nerve roots, these can be minimally stimulated to prevent neurological dysfunction [2].…”

Section: Discussionmentioning

confidence: 99%

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Intradural Dorsolumbar Disc Herniation: Case Report and Literature Review

Paz¹

2021

JCRR

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Intradural disc herniation is a rare entity, representing between 0.26% and 0.30% of all herniated discs. 92% of cases occur in the lumbar spine, more frequent at the L4-L5 level. The diagnostic and therapeutic conduct performed in a 61-year-old male patient who came to the office with a one-year and six-month history of dorsolumbar pain is described, accompanied by sensory alterations in the lower limbs. In view of the exacerbation of symptoms, a simple magnetic resonance study was performed, observing an intraspinal, intradural, extramedullary lesion at the D12-L1 space. An intradural disc herniation is suspected.After being evaluated the case in the group of Neurosurgeons (Group of Spinal Surgery) of the Institute of Neurology and Neurosurgery of Havana, it is proposed to carry out surgical treatment, which consisted of the extraction with microsurgical technique of the Herniated disc, preserving the vertebral anatomy through the laminoplasty technique, an open book variant. The patient evolved satisfactorily after three months of follow-up. It is concluded that intradural disc herniation should be included among intradural, extraxial lesions of the spine. By means of the magnetic resonance study, a group of imaging signs that support the preoperative diagnosis of this lesion can be described. Surgery is the definitive therapeutic method and allows an accurate diagnosis of spinal herniation to be established.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Intradural Dorsolumbar Disc Herniation: Case Report and Literature Review

Paz¹

2021

JCRR

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“…They originate from a tension failure of the annulus fibrosus to contain the nuclear portion of the disc in gel form [1]. Intradural disc herniation (IHD) constitutes a condition where the nucleus pulposus moves into the dural sac, separating from the intervertebral disc, previously passing through the posterior common longitudinal ligament (LLCP) [2]. In 1942 Dandy published the first case of a patient with HDI, since then only a low percentage of them have been reported in the medical literature.…”

Section: Introductionmentioning

confidence: 99%

“…There is a predominance in males, during the fifth and sixth decades of life. The patient frequently presents a picture of chronic back pain with acute exacerbation of pain accompanied by a rapidly onset focal motor defect [2,3].…”

Section: Introductionmentioning

confidence: 99%

Intradural Dorsolumbar Disc Herniation: Case Report and literature Review

Paz¹

2021

JNNS

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Intradural disc herniation is a rare entity, representing between 0.26% and 0.30% of all herniated discs. 92% of cases occur in the lumbar spine, more frequent at the L4-L5 level. The diagnostic and therapeutic conduct performed in a 61-year-old male patient who came to the office with a one-year and six-month history of dorsolumbar pain is described, accompanied by sensory alterations in the lower limbs. In view of the exacerbation of symptoms, a simple magnetic resonance study was performed, observing an intraspinal, intradural, extramedullary lesion at the D12-L1 space. An intradural disc herniation is suspected. After being evaluated the case in the group of Neurosurgeons (Group of Spinal Surgery) of the Institute of Neurology and Neurosurgery of Havana, it is proposed to carry out surgical treatment, which consisted of the extraction with microsurgical technique of the Herniated disc, preserving the vertebral anatomy through the laminoplasty technique, an open book variant. The patient evolved satisfactorily after three months of follow-up. It is concluded that intradural disc herniation should be included among intradural, extraxial lesions of the spine. By means of the magnetic resonance study, a group of imaging signs that support the preoperative diagnosis of this lesion can be described. Surgery is the definitive therapeutic method and allows an accurate diagnosis of spinal herniation to be established.

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“…However, a definitive diagnosis based on imaging features is challenging for several reasons. 8,21 First, the characteristic findings reported in the literature are not present in every case. 17,22 Nonetheless, IDH is highly suspected when the "hawk beak" sign, Y sign, ring enhancement, or "crumble disc" sign are observed on preoperative radiologic examination.…”

mentioning

confidence: 98%

Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis

Chen¹,

Ni²,

Xue³

et al. 2021

JPR

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Background: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre-and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms. Case Description: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient's pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up. Conclusion:Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.

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Challenges in intradural disc herniation diagnosis and surgery: A case report

Cited by 13 publications

References 10 publications

Intradural Dorsolumbar Disc Herniation: Case Report and Literature Review

Intradural Dorsolumbar Disc Herniation: Case Report and Literature Review

Intradural Dorsolumbar Disc Herniation: Case Report and literature Review

Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis

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