Intradural disc herniation - a case report

Abstract

Intradural disc herniation is a rare entity that occurs most commonly in the lumbar spine particularly at L4-L5 region. Most often it is diagnosed intraoperatively in a case of simple intervertebral disc herniation. Contrast enhanced MRI is mandatory for pre operative diagnosis. We describe a case of a 40-year-old female who presented to us with pain lower back, pain in both lower limbs and urinary retention after a fall. She had previously been diagnosed as a case of prolapsed intervertebral disc disease and was being managed conservatively. An unenhanced MRI revealed a large disc herniation at L4-L5 level. L4 and L5 laminectomy was performed and a hard intradural mass was palpable. On opening the dura a fragment of intervertebral disc was found with a small rent in the anterior dura. The fragment was removed and the rent was sutured. The patient recovered well from the surgery. Intradural disc herniations must be considered in the differential diagnosis of prolapsed intervertebral disc disease especially with recent worsening of symptoms and mismatch of unenhanced MRI findings with intraoperative findings. KeywoRds: Intradural disc, Diagnosis, L4-L5 level, Lumbar disc ÖZİntradural disk herniasyonu en sık olarak lumbar omurgada ve özellikle L4-L5 bölgesinde oluşan nadir bir durumdur. Genellikle basit intervertebral disk herniasyonu durumunda intraoperatif olarak tanı konur. Kontrast maddeli MRG preoperatif tanı için şarttır. Bize bir düşmeden sonra bel ağrısı, her iki bacakta ağrı ve üriner retansiyonla gelen 40 yaşında bir kadın vakayı sunuyoruz. Daha önce prolapse intervertebral disk hastalığı tanısı konmuştu ve konservatif olarak takip ediliyordu. Kontrast maddesiz MRG L4-L5 seviyesinde büyük bir disk herniasyonu gösterdi. L4 ve L5 laminektomi yapıldı ve sert bir intradural kitle palpe edildi. Dura açıldığında anterior durada küçük bir yırtıkla birlikte küçük bir intervertebral disk parçası bulundu. Parça çıkarıldı ve yırtık dikildi. Hastanın durumu cerrahiden sonra düzeldi. İntradural disk herniasyonları prolapse intervertebral disk hastalığının ayırıcı tanısında özellikle belirtiler yakın zamanda kötüleşmişse ve kontrast maddesiz MRG bulguları intraoperatif bulgularla eşleşmiyorsa düşünülmelidir.ANAHTAR sÖZCÜKLeR: İntradural disk, Tanı, L4-L5 seviyesi, Lumber disk

Against the Odds: Massive Lumbar Intradural Disk Herniation in the Elderly

“…Others have reported cases of traumatic intradural disk rupture in younger patients as well. 4 , 5 To our knowledge, so far no case of intradural disk herniation has been reported in a patient over the age of 75. 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 This may well account to the fact that intradural disk herniation is a rare event in general with approximately150 reported cases in the literature so far.…”

“…In even rarer instances, intradural disk herniations are related to trauma. 4 5 Here, we report an unusual case of a 90-year-old man undergoing emergency surgical procedure because of acute-onset neurogenic bladder dysfunction due to an intradural mass at the L2–L3 level with suspected intradural infection. However, intraoperative inspection proved the presence of intradural soft disk herniation.…”

Multiple Intradural Disc Herniations Masquerading as Intradural Extramedullary Tumors: A Case Report and Review of the Literature

“…Contrast-enhanced MRI is the gold standard for the diagnosis of intradural disc herniations 7 8) ; however, as in this case, diagnoses are often made during surgery 11 13) . Despite this, contrast-enhanced MRI is required for the differential diagnosis of spinal IDEM tumors such as schwannomas or meningiomas 11 17) . Rim enhancement is a typical feature of these tumors and is caused by chronic granulation tissue and/or peripheral neovascularization 11) .…”

“…Despite this, contrast-enhanced MRI is required for the differential diagnosis of spinal IDEM tumors such as schwannomas or meningiomas 11 17) . Rim enhancement is a typical feature of these tumors and is caused by chronic granulation tissue and/or peripheral neovascularization 11) . In some cases, rim enhancements of the lesion and PLL discontinuity were found on gadoliniumenhanced MRI 4) .…”

Intervertebral Disc Herniation With Intradural Migration of Fragments

“…Такие изменения могут приводить к нарушению прочностных и эластических свойств твердой мозговой оболочки [14]. Другими факторами, предрасполагающими к интрадуральной мигра-ции ткани диска, являются предшествующие операции, травмы, врожденный стеноз позвоночного канала, аномалии твердой мозговой оболочки, врожденное сращение твердой мозговой оболочки и задней продольной связки [8,11,16,22]. В нашем наблюдении у пациента имелся перидуральный фиброз, который, вероятно, развился после имевшегося у него в анамнезе дискорадикулярного конфликта.…”