Intradural disc herniation with cranial migration of an excluded fragment

Sarliève, P.; Delabrousse, É; Clair, C.; Hussein, H Haj; Schmitt, Christian; Kastler, B.

doi:10.1016/s0899-7071(03)00147-5

Cited by 22 publications

(24 citation statements)

References 7 publications

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“…The location of intradural disc herniations were reported at the intervertebral disc levels and above or under the levels connected with a stalk of disc. Disc fragments at midvertebral levels are rare; only one case reported that an intradural disc fragment with cranial migration was located among the cauda equina nerve roots at the L3 level [11]. In our case, the lesion was at the L5 level.…”

Section: Discussionmentioning

confidence: 51%

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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Section: Discussionmentioning

confidence: 51%

Intradural disc herniation at L5 level mimicking an intradural spinal tumor

et al. 2011

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“…Most of the published literature is on lumbar discectomy complications, such as postoperative wound hematoma, neuronal injury (including postoperative dysethesia), recurrent herniation, postoperative instability, wrong level of exposure, arachnoiditis, infection, incidental durotomy (including its long term sequelae), and pseudomeningoceles 1,2,5,9,18,26,35,[38][39][40]47,49,51,53,54) . In addition, there have been case reports of rare complications after lumbar discectomy, such as development of an arteriovenous fistula, major vessel injury, epidural fibrosis, ureteral injury, compartment syndrome with acute renal failure, iliac artery injury, intradural disc migration, bowel injury, septicemia, symptomatic pneumorachis, instrument failure, postoperative radicular neuroma, Ogilvie's syndrome, and reflex sympathetic dystrophy 3,4,10,12,13,[15][16][17]19,21,22,34,36,37,41,44,45,48,52) . In reports on cases subsequent to full endoscopic discectomy, published complications have included recurrent disc herniation on the same side, incomplete removal of a ruptured disc, infection, neuronal injury (including sensory changes), dural tears, vascular injury, psoas hematoma, and sympathetically mediated pain [6][7][8]11,14,[23][24][25]…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Post-Discectomy Pseudocyst after Endoscopic Lumbar Discectomy

Kang

Park

2011

J Korean Neurosurg Soc

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Objective : The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them. Methods : Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI). Results : Among 1,503 cases of all male soldiers, the MRIs showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach (p=0.001). The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP. Conclusion : Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach.

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“…There are no differentiating clinical signs between an extradural and intradural LDH, though the severity of neurological deficit is higher in the latter group [6].…”

Section: Discussionmentioning

confidence: 88%

Radicular interdural lumbar disc herniation

et al. 2009

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Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5-S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively.

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Intradural disc herniation with cranial migration of an excluded fragment

Cited by 22 publications

References 7 publications

Intradural disc herniation at L5 level mimicking an intradural spinal tumor

Intradural disc herniation at L5 level mimicking an intradural spinal tumor

Symptomatic Post-Discectomy Pseudocyst after Endoscopic Lumbar Discectomy

Radicular interdural lumbar disc herniation

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