Intradural disc herniation: how I do it

Rodrigo, Víctor; Claramonte, Marta; Martín, Mónica; Calatayud, Juan B.

doi:10.1007/s00701-018-3510-3

Cited by 10 publications

(11 citation statements)

References 8 publications

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“…First, they are most likely attributable to adhesions between the posterior longitudinal ligament (PLL), fibrous annulus, and the dural sac; a hole generated through the dura then allows for intradural disc migration. [10,11,14,15] Second, with congenital narrowing of the spinal canal, the decreased available epidural space results in congenital/ iatrogenic thickening of the dura with greater susceptibility to intradural disc rupture. [10,11,14,15]…”

Section: Discussionmentioning

confidence: 99%

Intradural disc herniation at the L1–L2 level: A case report and literature review

Aprígio¹,

Caramanti²,

Santos³

et al. 2019

Surgical Neurology International

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Background: Why are intradural disc herniations (IDHs) (0.3% of all discs) so infrequent? One explanation has been the marked adherence of the posterior longitudinal ligament (PLL) to the ventral wall of the dura. Variability in symptoms and difficulty in interpreting magnetic resonance (MR) images with/without contrast make the diagnosis of an IDH difficult. Here, we reported a patient with an L1–L2 IDH and appropriately reviewed the relevant literature. Case Description: A 57-year-old male presented with chronic low back and 1 month’s duration of the left thigh pain. The lumbar MR with/without contrast demonstrated an IDH at the L1–L2 level, resulting in spinal cord compression. At surgery, the disc herniation was appropriately resected, the dura was closed, and an interbody fusion with pedicle screw fixation was performed. Postoperatively, the patient clinically improved. Conclusion: IDHs are rare, being seen in only 0.3% of all cases. MR findings, performed with/without contrast, may help signal the presence of an IDH. MR findings include a hypointense structure inside the dura; the “hawk beak” sign (e.g., beak-like mass with ring enhancement at the intervertebral disc space); the Y sign (e.g., ventral dura split into ventral dura and arachnoid by disc material); an abrupt loss of continuity of the PLL; a diffuse annular bulge with a large posterocentral extrusion; and an typical crumbled appearance of disc (e.g., “crumble disc sign”). At surgery, both the extradural and intradural components of the disc must be excised.

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Section: Discussionmentioning

confidence: 99%

Intradural disc herniation at the L1–L2 level: A case report and literature review

Aprígio¹,

Caramanti²,

Santos³

et al. 2019

Surgical Neurology International

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“…Secondly, even with neuroimaging advances, it remains difficult to clearly differentiate IDH from other spinal pathologies such as benign tumor, arachnoiditis, hematoma, meningeal cyst, and metastasis. 8 , 25 , 29 , 30 Lumbar puncture can be performed to evaluate spinal pressure, and cytologic/molecular markers in CSF can be examined for differential diagnosis of IDH.…”

Section: Discussionmentioning

confidence: 99%

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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“…An intradural disc herniation is most often diagnosed intraoperatively and ultrasound can be utilised for intraoperative diagnosis [13,15]. We report on two cases presenting to our unit in the form of recurrent intradural disc disease following previous lumbar surgery occurring within 3 months of the index procedure in both cases.…”

Section: Introductionmentioning

confidence: 99%

Case Series-Intradural Disc in Recurrence of Lumbar Disc Prolapse and Review of Literature

Alhani¹,

Nagappa²,

Baird³

et al. 2020

COS

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Intradural disc herniation: how I do it

Abstract: Only intraoperative findings lead to a definitive diagnosis for intradural herniation. A durotomy needs to be performed. In this case, an arthrodesis was necessary to avoid complications of segmental instability.

Cited by 10 publications

References 8 publications

Intradural disc herniation at the L1–L2 level: A case report and literature review

Intradural disc herniation at the L1–L2 level: A case report and literature review

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

Case Series-Intradural Disc in Recurrence of Lumbar Disc Prolapse and Review of Literature

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