Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature

D’Andrea, Giancarlo; Trillò, Giuseppe; Roperto, Raffaelino; Celli, Paolo; Orlando, E; Ferrante, Luigi

doi:10.1007/s10143-003-0296-3

Cited by 100 publications

(137 citation statements)

References 38 publications

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“…However, given an option, surgeons tend to chose MRI as the diagnostic imaging of choice over CT (28% versus 15% respectively). This is in agreement with multiple comparison studies in the literature showing MRI to have superior sensitivity and specificity in diagnosing lumbar disc herniations compared to CT, especially in cases of intradural herniations [22][23][24] . Moreover, the morphometric features of the disc herniation are readily visible with MRI with the advantage of having no radiation exposure.…”

Section: Discussionsupporting

confidence: 91%

Lumbar Discectomy: A National Survey of Neurosurgeons and Literature Review

Cenic

Kachur

2009

Can. j. neurol. sci.

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The prevalence of symptomatic lumbar disc herniation is approximately 2% in the adult population 1 . When conservative therapy (e.g., analgesia, physiotherapy) does not provide optimum symptom relief, lumbar discectomy is regarded as the treatment of choice with a success rate of 74 to 98% 2 . However, the adjuvant pre-, intra-and post-operative management principles vary among practising neurosurgeons, such as the use of various diagnostic imaging techniques, epidural steroids, ABSTRACT: Background: To ascertain neurosurgical practices in the surgical management of one-level lumbar discectomies in the Canadian adult population. Methods: One page questionnaire faxed to each Neurosurgeon in Canada with questions relating to their practice in the management of this common neurosurgical procedure. All data analyzed using Chi-square statistics. Results: 112 completed surveys were returned hence, giving a 64% response rate with the respondents being predominantly adult neurosurgeons. Of the respondents, 88% perform lumbar discectomy in adults. Only 15% of respondents had a Spine Fellowship. For preoperative imaging, 44% use BOTH CT and MRI whereas 28% use only MRI and 15% use only CT. Prior to initial skin incision, 57% use a localization X-ray image. Preoperative antibiotics are prescribed by 92% of respondents. Majority of respondents (60%) use a pre-incision local anesthetic, whereas only a minority (44%) of respondents employ pre-closure intramuscular injection. With respect to magnification, 70% use microscope, 19% loupes, and 8% neither. Only 12% use minimally invasive tubular retractors. 68% remove "as much disc as possible", while 31% remove "ONLY herniated part". In the case of dural tears, 77% of respondents use fibrin glue (Tisseel®). Prior to skin closure, majority of neurosurgeons do NOT use a fat graft (72%), whereas 61% of respondents use epidural steroids. With respect to discharge from the hospital, 58% are discharged on the next day, 18% on the same day, and 23% in two days. Return to work is not recommended until at least six weeks post-op (96%). Most neurosurgeons (93%) would not operate on an individual with a chief complaint of low back pain. Conclusions: Our survey has identified variations in practice patterns amongst Canadian Neurosurgeons with respect to performing one-level lumbar discectomies. This survey is expected to form a basis for the design of a randomized controlled trial in the evaluation of the best management approach for this common neurosurgical procedure.RÉSUMÉ: Discectomie lombaire : enquête nationale chez les neurochirurgiens et revue de la littérature. Contexte : Le but de l'étude était d'examiner les pratiques chirurgicales concernant la discectomie lombaire à un seul niveau dans la population canadienne adulte. Méthodes : Un questionnaire d'une page, qui portait sur les techniques neurochirurgicales employées, a été envoyé par FAX à tous les neurochirurgiens du Canada. Toutes les données ont été analysées au moyen du test de Chi-carré. Résultats : Cent douze neurochirurg...

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Section: Discussionsupporting

confidence: 91%

Lumbar Discectomy: A National Survey of Neurosurgeons and Literature Review

Cenic

Kachur

2009

Can. j. neurol. sci.

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“…About 3% occur in the cervical region, 5% in thoracic region and 92% in the lumbar region [2]. The average age of onset of intradural disc herniations is between 50 and 60 years [4,5]. Clinical features in the cervical spine present a severe neurologic deficit such as Brown Sequard syndrome, incomplete or transient quadriparesis [5,6].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical features in the cervical spine present a severe neurologic deficit such as Brown Sequard syndrome, incomplete or transient quadriparesis [5,6]. In the lumbar spine, it will present with cauda equina syndrome found in two-thirds of the patients [3,7] or nerve root syndrome mimicking a spinal cord tumor [4]. Clinical history includes chronic lower back pain, acute radicular pain and progressive neurologic deficit [8].…”

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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“…Intradural disc herniation (IDH) is defined as the intervertebral disc nucleus pulposus displacement into the dural sac [1]. It was originally described by Dandy [2] in 1942, with an amount of circa 140 cases reported in literature until 2009 [3].…”

Section: Introductionmentioning

confidence: 99%

Intradural lumbar disc herniation: report of five cases with literature review

Ducati

Silva²,

Brandão³

et al. 2012

Eur Spine J

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Introduction Intradural lumbar disc herniations are uncommon presentations of a relatively frequent pathology, representing less than 1% of all lumbar disc hernias. They show specific features concerning their clinical diagnosis, with a higher incidence of cauda equina syndrome, and their surgical treatment requires a transdural approach. Methods In this article, we describe five cases of this pathology and review the literature as well as some considerations about the difficulties in the preoperative diagnostic issues and the surgical technique. Conclusion We concluded that for intradural disc herniations the diagnosis is mainly intraoperative, and the surgical technique has some special aspects.

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Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature

Cited by 100 publications

References 38 publications

Lumbar Discectomy: A National Survey of Neurosurgeons and Literature Review

Lumbar Discectomy: A National Survey of Neurosurgeons and Literature Review

Intradural disc herniation at L5 level mimicking an intradural spinal tumor

Intradural lumbar disc herniation: report of five cases with literature review

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