Spontaneous cervical intradural disc herniation

Warade, Abhijit G.; Misra, Basant K.

doi:10.1016/j.jocn.2013.06.011

Cited by 9 publications

(10 citation statements)

References 5 publications

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“…Thinning of the ventral dura with age may also play a role (13,14), as may developmental narrowing of the spinal canal (14). Nearly all of the few reported cervical cases have been traumatic in origin (16). Most symptomatic thoracic intradural disk herniations (discussed subsequently) are heavily calcified (12) (Fig 7).…”

Section: Intradural Disk Herniationmentioning

confidence: 99%

“…The clinical manifestations are variable, but cauda equina syndrome is common in lumbar cases, accounting for as many as approximately 30% of cases ( Fig 5). In the cervical and thoracic regions, the incidence of Brown-Séquard syndrome or severe myelopathy is high (Fig 7) (16). The diagnosis is often made during surgery (Fig 6; Movie), when an elusive extradural disk prompts an intradural exploration.…”

Section: Intradural Disk Herniationmentioning

confidence: 99%

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Uncommon Manifestations of Intervertebral Disk Pathologic Conditions

Diehn¹,

Maus²,

Morris³

et al. 2016

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Beyond the familiar disk herniations with typical clinical features, intervertebral disk pathologic conditions can have a wide spectrum of imaging and clinical manifestations. The goal of this review is to illustrate and discuss unusual manifestations of intervertebral disk pathologic conditions that radiologists may encounter, including disk herniations in unusual locations, those with atypical imaging features, and those with uncommon pathophysiologic findings. Examples of atypical disk herniations presented include dorsal epidural, intradural, symptomatic thoracic (including giant calcified), extreme lateral (retroperitoneal), fluorine 18 fluorodeoxyglucose-avid, acute intravertebral (Schmorl node), and massive lumbar disk herniations. Examples of atypical pathophysiologic conditions covered are discal cysts, fibrocartilaginous emboli to the spinal cord, tiny calcified disks or disk-level spiculated osteophytes causing spinal cerebrospinal fluid (CSF) leak and intracranial hypotension, and pediatric acute calcific discitis. This broad gamut of disease includes a variety of sizes of disk pathologic conditions, from the tiny (eg, the minuscule calcified disks causing high-flow CSF leaks) to the extremely large (eg, giant calcified thoracic intradural disk herniations causing myelopathy). A spectrum of clinical acuity is represented, from hyperacute fibrocartilaginous emboli causing spinal cord infarct, to acute Schmorl nodes, to chronic intradural herniations. The entities included are characterized by a range of clinical courses, from the typically devastating cord infarct caused by fibrocartilaginous emboli, to the usually spontaneously resolving pediatric acute calcific discitis. Several conditions have important differential diagnostic considerations, and others have relatively diagnostic imaging findings. The pathophysiologic findings are well understood for some of these entities and poorly defined for others. Radiologists' knowledge of this broad scope of unusual disk disease is critical for accurate radiologic diagnoses. Online supplemental material is available for this article. (©)RSNA, 2016.

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Section: Intradural Disk Herniationmentioning

confidence: 99%

Section: Intradural Disk Herniationmentioning

confidence: 99%

Uncommon Manifestations of Intervertebral Disk Pathologic Conditions

Diehn¹,

Maus²,

Morris³

et al. 2016

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“…Tables listing previous case reports have been published by Kansal et al (25 cases) and also by Pan et al (27 cases) [6, 7]. Warade listed just 23 reported cases in a paper published in 2014 [8]. Our own literature search found 31 cases in 26 reports as of May 2014.…”

Section: Discussionmentioning

confidence: 90%

“…Trauma is consistently listed by previous authors as a probable cause. Warade and Misra in 2014 claimed to have reported the first patient with a spontaneous cervical intradural disc herniation [8], but the results of our literature search suggested that only 7 out of 29 patients had a definite traumatic event. So while previous trauma may have played a role by inducing adhesions or by other modalities, it is not required as a precipitating event.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Cervical Intradural Disc Herniation Associated with Ossification of Posterior Longitudinal Ligament

Wang

Shen³

2014

Case Reports in Orthopedics

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Intradural herniation of a cervical disc is rare; less than 35 cases have been reported to date. A 52-year-old man with preexisting ossification of posterior longitudinal ligament developed severe neck pain with Lt hemiparesis while asleep. Neurological exam was consistent with Brown-Séquard syndrome. Magnetic resonance images showed a C5-6 herniated disc that was adjacent to the ossified ligament and indenting the cord. The mass was surrounded by cerebrospinal fluid signal intensity margin, and caudally the ventral dura line appears divided into two, consistent with the “Y-sign” described by Sasaji et al. Cord edema were noted. Because of preexisting canal stenosis and spinal cord at risk, a laminoplasty was performed, followed by an anterior C6 corpectomy. Spot-weld type adhesions of the posterior longitudinal ligament to the dura was noted, along with a longitudinal tear in the dura. An intradural extra-arachnoid fragment of herniated disc was removed. Clinical exam at 6 months after surgery revealed normal muscle strength but persistent mild paresthesias. It is difficult to make a definite diagnosis of intradural herniation preoperatively; however, the clinical findings and radiographic signs mentioned above are suggestive and should alert the surgeon to look for an intradural fragment.

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“…Intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations and there have been a total of 31 cervical IDHs reported in the literature. 1 – 4 Because the pathogenesis and imaging characteristics of IDH are not fully understood, a preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. 5 We provide 1 additional case report, along with a brief review of the literature.…”

Section: Introductionmentioning

confidence: 99%

Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy

Yang

Eun

2016

Medicine

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Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was <3.A 32-year-old man was transferred our emergency department with progressive quadriparesis. He had no history of trauma, but had received physical therapy with spinal manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4–C5 and C5–C6 that caused severe spinal cord compression and surrounding edema. We performed C4–C5–C6 anterior cervical discectomy and fusion.The patient's limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had recovered nearly full muscle power.We presented an extremely rare case of cervical IDH causing progressive quadriparesis after excessive spinal manipulation therapy. The presence of a “halo” and “Y-sign” were useful MRI markers for cervical IDH in this case.

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Spontaneous cervical intradural disc herniation

Cited by 9 publications

References 5 publications

Uncommon Manifestations of Intervertebral Disk Pathologic Conditions

Uncommon Manifestations of Intervertebral Disk Pathologic Conditions

Spontaneous Cervical Intradural Disc Herniation Associated with Ossification of Posterior Longitudinal Ligament

Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy

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