Intradural disc herniation: Radiographic findings and surgical results with a literature review

Kobayashi, Kazuyoshi; Matsubara, Yumiko; Yoshihara, Hisatake; Hirano, Ken‐ichi; Ito, Zenya; Ando, Kei; Ukai, Junichi; Muramoto, Akio; Shinjo, Ryuichi; Matsumoto, Tomohiro; Nakashima, Hiroaki; Ishiguro, Naoki

doi:10.1016/j.clineuro.2014.06.033

Cited by 29 publications

(23 citation statements)

References 19 publications

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“…11 Third, as the most common segment of lumbar disc herniation, the L4-L5 levels are often associated with annulus fibrosus rupture. 12 The aforementioned reasons facilitate disc fragments that penetrate the PLL and dural sac. In the present case, IDDH occurred at the L4-L5 levels, which may be related to the above-mentioned reasons.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 Wasserstrom et al reported that IDDH may mimic an intradural tumor; 19 however, the following MRI findings can distinguish it from the latter: location close to intervertebral disc disease, whorl-like mixed intensity on T2-weighted MRI, poor visualization on T1-weighted MRI, and marked ring enhancement following the administration of gadolinium. 12 IDDH could enhance MRI because it was surrounded by vascular tissue rich in blood vessels, which was considered to be the most specific imaging finding. 19 However, IDDH is difficult and seldom suspected preoperatively; thus, there is little opportunity to observe the most specific imaging finding preoperatively, as enhanced MRI is not performed routinely for lumbar degenerative disease.…”

Section: Discussionmentioning

confidence: 99%

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<p>Intradural Lumbar Disc Herniation: A Case Report and Literature Review</p>

Ge¹,

Hao²,

Yan³

et al. 2019

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Background: Lumbar disc herniation into the dural space is a very rare phenomenon of degenerative lumbar lesions in the elderly population, and its potential pathogenesis and natural course remain unclear. Case description: We describe a rare case of intradural lumbar disc herniation. A 68-yearold man presented with progressive lower back pain and radiating pain and numbness in both legs for 3 years. Magnetic resonance imaging revealed a large herniated disc at L4-L5. Posterior discectomy and fusion of the L4-L5 was performed after conservative treatment failed. Intraoperatively, only minimal disc fragments in the epidural space were found after meticulous probing following laminectomy of the L4-L5 vertebrae. The dorsal dura mater was saturated, tense, and bulged at the L4-L5 levels; additionally, an intradural mass was palpable and confirmed by intraoperative ultrasonography. Subsequently, dorsal middle durotomy was performed. Upon opening the dural sac, a large cauliflower-like mass similar to nucleus pulposus tissue was found near the arachnoid membrane. The mass was dissociative and could be completely resected. The dorsal dural incisions were closed after careful exploration, followed by fixation and fusion of the L4-L5 levels. Pathological examination revealed disc tissue with central balloon-type cystic degenerative changes. The patient's lower back pain and radiating pain and numbness of both legs improved remarkably postoperatively, and he became asymptomatic at 3 months postoperatively. Conclusion: Intradural lumbar disc herniation should be highly suspected when intraoperative findings are incompatible with findings from the preoperative imaging examination, and it could be further confirmed via intraoperative ultrasonography and pathological examination of the resected tissue from the dural space. Prompt surgery is recommended, and surgical results are usually favorable. We also reviewed the literature and discussed the potential pathogenesis, natural course, diagnosis, and treatment of intradural lumbar disc herniation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

<p>Intradural Lumbar Disc Herniation: A Case Report and Literature Review</p>

Ge¹,

Hao²,

Yan³

et al. 2019

CIA

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“…Грыжи межпозвонковых дисков, фрагменты которых мигрируют интрадурально, встречаются достаточно редко. По данным литературы, их частота колеблется в пределах 0,2-2,2 % от общего количества грыж всех локализаций [9,16]. В 2007-2015 гг.…”

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“…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.…”

unclassified

“…Ушива-ние дефекта на вентральной поверхности дурального мешка при дорсальных доступах в большинстве случаев невозможно из-за трудности визуализации и малого хирургического поля. При необходимости детального осмотра трудновизуализируемого дефекта нужно расширять операционный доступ, жертвуя при этом стабильностью позвоночно-двигательного сегмента [16]. По возможности, дефект должен быть закрыт с помощью специального клея, гемостатического материала, аутомышцы или аутожира [9,12].…”

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Intervertebral Disc Herniation With Intradural Migration of Fragments

Baikov¹,

Krutko²

2016

Hir. pozvonoč.

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The paper presents analytical review of the literature on the problem of surgical treatment of patients with intradural migration of intervertebral disc hernias and a clinical case of intradural herniated disc in the lumbar spine. Despite advances in neuroimaging and modification of methods and surgical techniques, this pathology is rarely diagnosed preoperatively. Its surgical treatment involves considerable technical difficulties and is associated with high rate of revision operations. The study material included abstracts of articles from the PubMed database and articles published in The

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