Intradural disc a diagnostic dilemma: Case series and review of literature

Sharma, Ayush; Singh, Vijay; Sangondimath, Gururaj; Kamble, Prashant

doi:10.4103/ajns.ajns_55_17

Cited by 16 publications

(27 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, they are most likely attributable to adhesions between the posterior longitudinal ligament (PLL), fibrous annulus, and the dural sac; a hole generated through the dura then allows for intradural disc migration. [10,11,14,15] Second, with congenital narrowing of the spinal canal, the decreased available epidural space results in congenital/ iatrogenic thickening of the dura with greater susceptibility to intradural disc rupture. [10,11,14,15]…”

Section: Discussionmentioning

confidence: 99%

Intradural disc herniation at the L1–L2 level: A case report and literature review

Aprígio¹,

Caramanti²,

Santos³

et al. 2019

Surgical Neurology International

View full text Add to dashboard Cite

Background: Why are intradural disc herniations (IDHs) (0.3% of all discs) so infrequent? One explanation has been the marked adherence of the posterior longitudinal ligament (PLL) to the ventral wall of the dura. Variability in symptoms and difficulty in interpreting magnetic resonance (MR) images with/without contrast make the diagnosis of an IDH difficult. Here, we reported a patient with an L1–L2 IDH and appropriately reviewed the relevant literature. Case Description: A 57-year-old male presented with chronic low back and 1 month’s duration of the left thigh pain. The lumbar MR with/without contrast demonstrated an IDH at the L1–L2 level, resulting in spinal cord compression. At surgery, the disc herniation was appropriately resected, the dura was closed, and an interbody fusion with pedicle screw fixation was performed. Postoperatively, the patient clinically improved. Conclusion: IDHs are rare, being seen in only 0.3% of all cases. MR findings, performed with/without contrast, may help signal the presence of an IDH. MR findings include a hypointense structure inside the dura; the “hawk beak” sign (e.g., beak-like mass with ring enhancement at the intervertebral disc space); the Y sign (e.g., ventral dura split into ventral dura and arachnoid by disc material); an abrupt loss of continuity of the PLL; a diffuse annular bulge with a large posterocentral extrusion; and an typical crumbled appearance of disc (e.g., “crumble disc sign”). At surgery, both the extradural and intradural components of the disc must be excised.

show abstract

Section: Discussionmentioning

confidence: 99%

Intradural disc herniation at the L1–L2 level: A case report and literature review

Aprígio¹,

Caramanti²,

Santos³

et al. 2019

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…Another theory is the "chronic compression" hypothesis. 3 Lee and Fairholm thought that long-term mechanical compression of structures, such as intervertebral discs and osteophytes, could make the dura mater thinner and fragile, facilitating penetration of the dural sac by the nucleus pulposus. 14 Besides, the "adhesions" hypothesis is advocated by some researchers.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, most herniated nucleus pulposi are located epidurally, outside or under the posterior longitudinal ligament. Intradural disc herniation (IDDH), when the nucleus pulposus penetrates the posterior longitudinal ligament (PLL) and the anterior wall of the dura and migrates intrathecally, 3 is very uncommon and accounts for only 0.04-0.33% of all lumbar disc herniations. 4,5 The pathogenesis and natural course of IDDH remain unclear.…”

Section: Introductionmentioning

confidence: 99%

<p>Intradural Lumbar Disc Herniation: A Case Report and Literature Review</p>

Ge¹,

Hao²,

Yan³

et al. 2019

CIA

View full text Add to dashboard Cite

Background: Lumbar disc herniation into the dural space is a very rare phenomenon of degenerative lumbar lesions in the elderly population, and its potential pathogenesis and natural course remain unclear. Case description: We describe a rare case of intradural lumbar disc herniation. A 68-yearold man presented with progressive lower back pain and radiating pain and numbness in both legs for 3 years. Magnetic resonance imaging revealed a large herniated disc at L4-L5. Posterior discectomy and fusion of the L4-L5 was performed after conservative treatment failed. Intraoperatively, only minimal disc fragments in the epidural space were found after meticulous probing following laminectomy of the L4-L5 vertebrae. The dorsal dura mater was saturated, tense, and bulged at the L4-L5 levels; additionally, an intradural mass was palpable and confirmed by intraoperative ultrasonography. Subsequently, dorsal middle durotomy was performed. Upon opening the dural sac, a large cauliflower-like mass similar to nucleus pulposus tissue was found near the arachnoid membrane. The mass was dissociative and could be completely resected. The dorsal dural incisions were closed after careful exploration, followed by fixation and fusion of the L4-L5 levels. Pathological examination revealed disc tissue with central balloon-type cystic degenerative changes. The patient's lower back pain and radiating pain and numbness of both legs improved remarkably postoperatively, and he became asymptomatic at 3 months postoperatively. Conclusion: Intradural lumbar disc herniation should be highly suspected when intraoperative findings are incompatible with findings from the preoperative imaging examination, and it could be further confirmed via intraoperative ultrasonography and pathological examination of the resected tissue from the dural space. Prompt surgery is recommended, and surgical results are usually favorable. We also reviewed the literature and discussed the potential pathogenesis, natural course, diagnosis, and treatment of intradural lumbar disc herniation.

show abstract

“…Intradural disc herniation is a rare entity reported at 0.04 % to 1.1% by Sharma A et al that occurs most commonly in the lumbar spine particularly at L4-L5 region [1]. Lechowski et al presented 11 cases of intradural lumbar disc herniations from 2030 (<0.05%) patients treated surgically for intervertebral disc prolaps while Schisano G et al reported nine cases of intradural herniations (1.51%) in 593 cases of ruptured lumbar disc that underwent surgery from 1980 to 1992 [6].…”

Section: Introductionmentioning

confidence: 99%

“…Lechowski et al presented 11 cases of intradural lumbar disc herniations from 2030 (<0.05%) patients treated surgically for intervertebral disc prolaps while Schisano G et al reported nine cases of intradural herniations (1.51%) in 593 cases of ruptured lumbar disc that underwent surgery from 1980 to 1992 [6]. All authors concluded that the frequency of intradural disc rupture is very low [1,6,7].…”

Section: Introductionmentioning

confidence: 99%