Intradural Disc Herniation: A Case Report and Literature Review

Ashraf, Almas; Babar, Zaheer-ud-Din

doi:10.7759/cureus.7600

Cited by 7 publications

(9 citation statements)

References 8 publications

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“…Hence, the scarcity of literature on spectrum of such diseases warrants the need for discussions over rare cases from all over the globe. The common age group reported for ILDH is 60 years or older population, but a few young patients aged 21 and 30 years were also documented, which correlates with the patient reported in our case as well [6,[8][9][10][11][12][13].…”

Section: Discussionsupporting

confidence: 90%

“…According to previously reported cases, sensory deficits at the level of the L4-L5 dermatome, along with mild motor weakness in the muscles of the foot, urinary incontinence, gait disturbances, and progressive lower limb weakness, were documented as a spectrum of presenting symptoms in various literatures of different previously published cases, while in contrast, our patient had none [8,10].…”

Section: Discussionmentioning

confidence: 45%

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Herniating Intradural Disc at Lumbar L4-L5 Level: A Case Report

Javeed¹,

Khan²,

Rehman³

2023

Cureus

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Prolapse of intervertebral disc is a common pathology seen in the neurosurgery field but intradural lumbar disc herniation is a rare entity encountered only during the surgical treatment of prolapse. We present a 30year-old male who reported lower back pain radiating to the right lower limb for the last 2.5 years. The pain started after a brief history of weight lifting. There were no associated motor or sensory deficits. The magnetic resonance imaging of the lumbosacral spine showed prolapse of intervertebral disc at the level of lumbar L4-L5. The patient underwent laminectomy and intradural discectomy of L4-L5. Patient had a smooth post-operative recovery with no neurological deficits. A thorough radiological examination can aid in the pre-operative diagnosis of an intradural lumbar disc herniation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 45%

Herniating Intradural Disc at Lumbar L4-L5 Level: A Case Report

Javeed¹,

Khan²,

Rehman³

2023

Cureus

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“…Low et al proposed that, in the treatment of upper lumbar ILDH, due to anatomical reasons, such as spinal stenosis, short lamina, nearly vertical facet joints, and a full dural sac, it is recommended to perform microscopic surgery after total laminectomy (29). Ashraf and Babar reported a case of lumbar 4/5 giant intervertebral disc herniation with cauda equina syndrome (30). Routine laminectomy and durotomy were performed to remove free fragments, and the dura mater was closed in 1 stage.…”

Section: Treatmentmentioning

confidence: 99%

Intradural disc herniation at the L2/3 level: a case report and literature review

Wen¹,

Xiao²,

Chen³

et al. 2022

Ann Palliat Med

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Background: Intradural lumbar disc herniation (ILDH) is special type of lumbar disc herniation in which the lumbar nucleus pulposus prolapses and enters the dura mater. ILDHs comprise 0.04-0.33% of all herniated discs. In most cases, the diagnosis could not be confirmed preoperatively by identifying the typical features of ILDH in radiological evaluation. In the current report, we present a case of ILDH at lumbar 2/3 level and discuss the clinical presentations, typical imaging features, treatments, and outcomes.Case Description: We describe a rare case of ILDH. The patient was a 65-year-old man with pain in waist and back, and with bilateral radiating pain of lower extremities and fatigue for more than 2 weeks.Magnetic resonance imaging (MRI) revealed a large round, low-density mass at lumbar 2/3, which was easily mimicked as an intradural spinal tumor lesion. While enhanced MRI showed the typical rim enhancement sign and "Hawk beak" sign. Due to progressive decrease in muscle strength in both lower limbs, posterior microscopically assisted laminectomy, dural incision of the lumbar 2/3 was performed. Pathological examination revealed degenerated fibrous connective tissue and cartilage tissue. The patient's lower back pain and radiating pain and numbness of both legs improved remarkably postoperatively, and he became asymptomatic at 3 months and 1-year postoperatively.Conclusions: ILDH is a rare intervertebral disc herniation in clinical practice. The pathogenesis of ILDH may be related to aseptic inflammatory edema, closely fixing of ventral dura and the posterior longitudinal ligament, repeated mechanical action and chemical corrosion. Typical rim enhancement sign, "Hawk beak" sign and "Y" sign are important features of MRI in diagnosing ILDH, and intraspinal gas is also helpful in computed tomography (CT) diagnosis of ILDH. Prompt microscopically assisted laminectomy, dura mater incision to remove the intradural disc, pedicle screw fixation regardless of fusion, surgical results are usually favorable. We also reviewed the literature and discussed the epidemiology, potential pathogenesis, diagnosis, treatment and poor prognostic factors of ILDH.

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“…Another theory is that chronic compression leads to a thinner dura mater. Compression may be caused by congenital stenosis, congenital reduction in dura thickness, or iatrogenic causes after an operative procedure [ 1 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%