Intradural lumbar disc herniation: illustrative case

Abstract

BACKGROUND Accounting for less than 0.4% of disc herniations, intradural lumbar disc herniations (ILDHs) are a rare occurrence primarily described as a complication after lumbar spine surgery. It is speculated that the herniation may propagate intradurally from either an unrecognized dural defect after initial surgery or as a result of adhesions between the dura and posterior longitudinal ligament. This report explores the etiology, presentation, diagnostic evaluation, and treatment of ILDH along with a case report and microsurgery video. OBSERVATIONS A 67-year-old patient who 1 year earlier had undergone an L2–5 laminectomy and L2–3 decompression with no known complications presented with low back pain and radiating right leg, buttock, and groin pain for 1 month. Physical examination indicated no numbness or weakness. Magnetic resonance imaging demonstrated a large ILDH. A transforaminal interbody fusion was performed followed by a durotomy, ILDH removal, and dural closure. A ventral dural defect was found and repaired during the procedure. LESSONS The treatment for ILDH is laminectomy with dorsal durotomy. Because ILDH has rarely been described in literature, understanding its presentation is crucial for prompt identification and management.

Herniating Intradural Disc at Lumbar L4-L5 Level: A Case Report

“…Hence, the scarcity of literature on spectrum of such diseases warrants the need for discussions over rare cases from all over the globe. The common age group reported for ILDH is 60 years or older population, but a few young patients aged 21 and 30 years were also documented, which correlates with the patient reported in our case as well [6,[8][9][10][11][12][13].…”

“…While ruling out the causes, Ihejirika et al claimed that ILDH is either secondary to a previous lumbar spine surgical intervention or a result of pre-existing adhesions between the posterior longitudinal ligament and dura [6]. In contrast, our patient had no history of any sort of spinal surgery in his lifetime.…”

“…The total count of reported cases since 1942 has only crossed the mark of 120 patients [5]. Incidence documented in literature is only 0.4% or less out of all disc herniations, while 92% out of these involve lumbar region [6,7]. Hence, the scarcity of literature on spectrum of such diseases warrants the need for discussions over rare cases from all over the globe.…”

Intradural disc herniation: case report

“…During the anamnesis and physical examination, it is noticed that the patients present chronic low back pain, acute radicular pain and progressive neurological deficit as symptoms (13). As the diagnosis is intraoperative, it is extremely important that the surgery be performed as soon as possible (14,15), not only to decrease or slow down the progression of the neurological deficit, but also to provide relief from signs and symptoms, the most relevant being pain (16,17).…”