Intradural lumbar disc herniations at the L1–L2 level: A case study and literature review

Ponzo, Giancarlo; Furnari, Massimo; Umana, Giuseppe Emmanuele; Giuffrida, Massimiliano; Nicoletti, Giovanni Federico; Scalia, Gianluca

doi:10.25259/sni_108_2020

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…[ 17 , 23 ] Since Dandy first reported an IDH in 1942,[ 7 ] we were able to identify nine cases of IDH at the L1-2 level in the English literature. [ 1 , 2 , 15 , 17 , 18 , 23 , 24 , 26 , 28 , 29 ]…”

Section: Discussionmentioning

confidence: 99%

Intradural disc herniation at the L1-2 level

Serikyaku¹,

Higa²,

Yara³

2021

Surgical Neurology International

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Background: Intradural disc herniations (IDHs) are rare, are difficult to diagnose on preoperative MR/CT imaging, and typically, are most readily confirmed at the time of surgery. However, one of the greatest challenges posed by these lesions, is the repair of the ventral dural rent. Case Description: A 55-year-old male with a 20-year history of lumbago presented with low back pain and right lower extremity sciatica of 3 months’ duration. The MR and CT studies showed a compressive lesion at the L1-2 level. There was no original suspicion that this was an IDH. At surgery, performed under the operating microscope, a subtotal L1-L2 laminectomy was performed (i.e. while lysing severe adhesions between the posterior longitudinal ligament and the ventral dura, a traumatic durotomy occurred. White, spongious, friable, soft tissue, and free-floating disc fragments extruded through the durotomy site. Notably, it was initially considered to be a tumor rather than a disc. Once all fragments had been delivered, unsuccessful attempts were made to repair the ventral dura. Further efforts were curtailed due to concern that they would result in damage to multiple ventral nerve rootlets. Despite the lack of primary dural repair, the secondary measures resulted in no postoperative recurrent cerebrospinal fluid leakage (CSF) and a smooth postoperative surgical course. Conclusion: IDH at the L1-2 level is rare, and preoperative MR/CT studies may not always document their intradural location. Ideally, ventral dural tears attributed to these lesions should be directly repaired and/or managed with additional adjunctive CSF leak repair techniques (i.e. muscle patch grafts, microfibrillar collagen, and fibrin sealants).

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Section: Discussionmentioning

confidence: 99%

Intradural disc herniation at the L1-2 level

Serikyaku¹,

Higa²,

Yara³

2021

Surgical Neurology International

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“… 6 , 20 At this point, patients with chronic intermittent pain may experience acute and more serious neurologic symptoms. 16 Our patient had a history of chronic lower back and leg pain resulting from a lumbar sprain that progressed to serious acute pain, which was highly suspected to be caused by disc degeneration.…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…Patients who have an intraoperative diagnosis of upper lumber IDH frequently exhibit intermittent neurogenic symptoms for months/years and are referred to the hospital upon experiencing acute onset of back pain with or without neurological deficits. 16,17 A herniated disc combined with annulus fibrosus rupture can lead to the formation of a local "fingertip" structure that squeezes and firmly affixes the PLL to the dural sac. Accompanied by frequent lumbar movement-especially in the upper lumbar spine which has greater mobility than in the lower lumbar segments-the fingertip structure can repeatedly press the PLL and dura mater to promote adhesion.…”

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confidence: 99%

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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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“…Intradural disc herniation (IDH) is a rare entity accounting for 0.26–0.3% of all disc herniations [ 1 , 4 , 7 ]. They typically occur at the lower lumbar spine (92%) and are usually associated with neurological deteriorations and/or local pain [ 3 , 6 , 7 , 8 , 12 ]. Here, we present the case of a 50-year-old patient who was admitted merely with orthostatic headache due to a CSF leak caused by an IDH at the level of T12/L1 with radiological signs of a cervical myelomalacia caused by an engorged epidural venous plexus.…”

Section: Introductionmentioning

confidence: 99%

Case report of a cervical myelomalacia caused by a thoracolumbar intradural disc herniation leading to intracranial hypotension

et al. 2020

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A 50-year-old patient was admitted with symptoms of intracranial hypotension. MRI revealed a cervical myelomalacia caused by engorged epidural veins leading to a stenosis of the spinal canal. This condition is rarely described in patients with hydrocephalus and ventricular shunts suffering from chronic overdrainage. However, the reason in this patient was a CSF leak caused by an intradural disc herniation at T12/L1. After surgery, symptoms resolved and the cervical myelomalacia and the swollen epidural veins disappeared on postoperative MRI. In patients with engorged cervical epidural veins without a ventricular shunt, a CSF leak has to be considered.

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Intradural lumbar disc herniations at the L1–L2 level: A case study and literature review

Cited by 9 publications

References 7 publications

Intradural disc herniation at the L1-2 level

Intradural disc herniation at the L1-2 level

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

Case report of a cervical myelomalacia caused by a thoracolumbar intradural disc herniation leading to intracranial hypotension

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