Intradural Disc Herniation and Epidural Gas: Something More Than a Casual Association?

Hidalgo-Ovejero, Ángel; García-Mata, Serafín; Gozzi-Vallejo, Sonia; Izco-Cabezón, Tomás; Martínez-Morentín, Javier; Martínez-Grande, Manuel

doi:10.1097/01.brs.0000142433.21912.0d

Cited by 71 publications

(55 citation statements)

References 48 publications

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“…2,3,7 Such adhesions may be congenital or develop after previous spinal surgery or trauma due to scar tissue formation. 7,8 In the present case, intradural LDH occurred subsequent to a dural tear during PELD, which has not been previously reported.…”

Section: Discussionsupporting

confidence: 47%

“…Hidalgo-Ovejero et al reported that the potential presence of intradural LDH must always be considered when performing open discectomy in cases in which CT shows the presence of epidural gas. 8 Several authors have reported that MRI is the most useful imaging modality in cases of intradural LDH. Characteristic findings are the loss of PLL continuity and the "hawk-beak" sign, which shows a triangular aspect of the herniated disc compressed laterally.…”

Section: Discussionmentioning

confidence: 99%

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Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report

Tamaki

Sakai

Miyagi

et al. 2015

SPI

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A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4–5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report

Tamaki

Sakai

Miyagi

et al. 2015

SPI

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“…The herniated discs appear as homogeneously isointense lesions on T1-and T2-weighted images. Hidalgo-Ovejero et al [16] pointed out the significance of gas within the spinal canal, which was associated with intradural disc herniations. Hida et al [17] stressed the usefulness of gadolinium-enhanced MRIs in making an accurate diagnosis preoperatively by showing a beak-like mass with ring enhancement at the level of the intervertebral space, which pointed to the abrupt loss of continuity of the PLL.…”

Section: Discussionmentioning

confidence: 99%

Intradural disc herniation at L5 level mimicking an intradural spinal tumor

et al. 2011

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Intradural lumbar disc herniation is a rare complication of disc disease. The reason for the tearing of the dura matter by a herniated disc is not clearly known. Intradural disc herniations usually occur at the disc levels and are often seen at L4-L5 level but have also been reported at other intervertebral disc levels. However, intradural disc herniation at mid-vertebral levels is rare in the literature and mimics an intradural extramedullary spinal tumor lesion in radiological evaluation. Although magnetic resonance imaging (MRI) with gadolinium is useful in the diagnosis of this condition, preoperative correct diagnosis is usually difficult and the definitive diagnosis must be made during surgery. We describe here a 50-year-old female patient who presented with pain in the lower back for 6 months and a sudden exacerbation of the pain that spread to the left leg as well as numbness in both legs for 2 weeks. MRI demonstrated an intradural mass at the level of L5. Laminectomy was performed, and subsequently durotomy was also performed. An intradural disc fragment was found and completely removed. The patient recovered fully in 3 months. Intradural lumbar disc herniation must be considered in the differential diagnosis of mass lesions in the spinal canal.

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“…13,19) Disk degeneration is intimately related to the vacuum phenomenon, which is relatively common in old age. The gas associated with the vacuum phenomenon has been found in the spinal canal, intervertebral foramen, epidural space, and subarachnoid space, 8,17) but disk herniation with gas has rarely been reported. The majority of these cases have been the result of nonoperative treatments.…”

Section: Introductionmentioning

confidence: 99%

Surgical Experience of Gas-Containing Disk Herniation

Choi

Kim

Lee

2010

Neurol. Med. Chir.(Tokyo)

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Disk herniation with gas or gas-containing disk herniation (GCDH) is rare, although epidural gas is associated with the vacuum phenomenon. The clinical, radiologic, and surgical findings were retrospectively analyzed of 18 patients with GCDH. The demographic, clinical, and radiologic findings including computed tomography and magnetic resonance imaging, as well as operative methods were examined. The mean age was 64.4 years (range 51-84 years). All patients presented with acute radiculopathy or exacerbation of chronic pain associated with GCDH of the lumbar spine. All lumbar GCDHs were related to the vacuum phenomenon. Ruptured disks predominantly compressed the nerve root with gas in 17 cases, except in one with only compressed nerve root by gas without disk herniation. All patients had confirmed GCDH at surgery. All patients underwent removal of GCDH and five with another level of spinal stenosis or disk herniation underwent selective decompression. The six patients with instability underwent fusion. Visual analogue scale score of radicular pain was improved from 7.4 ± 0.9 before surgery to 3.2 ± 0.7 at the 3-month follow-up examination. No recurrence occurred after surgery. GCDH can occur as a space-occupying lesion in epidural space as well as a cause of radiculopathy. GCDH may indicate the source of clinical symptoms in the degenerative spine, especially combined with spinal stenosis or multiple spinal disk herniations.

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Intradural Disc Herniation and Epidural Gas: Something More Than a Casual Association?

Cited by 71 publications

References 48 publications

Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report

Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report

Intradural disc herniation at L5 level mimicking an intradural spinal tumor

Surgical Experience of Gas-Containing Disk Herniation

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