Intradural lumbar disc herniation: report of two cases

Koç, Rahmi Kemal; Akdemir, Hidayet; Oktem, Ibrahim; Menkü, Ahmet

doi:10.1007/pl00011967

Cited by 48 publications

(54 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At surgery, the dura and root must be carefully explored. IDH needs to be recognized and treated appropriately at the time of the initial operation to prevent the development of the back failure (8,7). Cauda equina syndrome and sphincter disease have an incidence of 30% of all reported cases, as in our case (3).…”

Section: Imaging Of Idh Requires Contrast Enhanced Mri (3)mentioning

confidence: 77%

Intradural disc herniation - a case report

Sk¹,

Sundar²,

Sharma³

et al. 2012

Turkish Neurosurgery

View full text Add to dashboard Cite

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

show abstract

Section: Imaging Of Idh Requires Contrast Enhanced Mri (3)mentioning

confidence: 77%

Intradural disc herniation - a case report

Sk¹,

Sundar²,

Sharma³

et al. 2012

Turkish Neurosurgery

View full text Add to dashboard Cite

show abstract

“…The diagnosis is commonly an intraoperative surprise because contrast MRI is not routinely advised in evaluation of radicular pain. Intraradicular disc protrusion might result in failure of lumbar disc surgery [5][6][7][8][9][10][11][12]. Therefore the intervertebral foramina and roots must be carefully explored in every case of lumbar disc herniation.…”

Section: Resultsmentioning

confidence: 99%

Intradural Lumbar Disc Herniation Associated with Degenerative Spine Disease

Wang¹

2015

Int J Neurorehabilitation Eng

View full text Add to dashboard Cite

The first case of lumbar intradural disc herniation was reported as early as 1942; since then more than 150 cases have been reported, mostly in the lumbar spine. Gadolinium-enhanced magnetic resonance image (MRI) is considered the "gold standard" for diagnosing this entity, although it is rarely performed routinely in lumbar disc disease and diagnosis is often made intra-operatively and in retrospect in regard to the imaging.A 63-year-old Italian man presented to the emergency department complaining of lower back pain, difficulty in walking, and in urination, with bilateral leg pain. On examination, he showed uneven gait, pain in the right thigh and leg with intact sphincter function. A magnetic resonance image of the lumbar spine showed a large mediolateral herniated disc at L3-L4, also the patient had a stenosis at the thoracic level at T11-T12 and T12-L1. The plan was to do an MRI with Gado however the patient went into retention and so was operated before the MRI with Gado.Results: Intraoperatively the pathology was first identified as a big cyst like structure, that as thought to be a synovial cyst, and then once it was opened it turned out to be an intradural extension of a herniated disc. Decompression was also done at the thoracic level and finally instrumentation was done from T10 to S1. Conclusion:Intradural lumbar disc herniations are a rare entity, most of the time the diagnosis is not made pre operatively, however once it is diagnosed intra-operatively, careful removal of the herniated material should be done to avoid damaging the rootlets, sometimes u have double pathologies that need to be addressed like in this patient where he had both lumbar and thoracic stenoses.Keywords: Disc; Intradural; Lumbar stenosis; Thoracic stenosis; Decompression; Dual pathology Case ReportThe first case of lumbar intradural disc herniation was reported in 1942 [1] since then, more than 150 cases have been reported, mostly affecting the lumbar spine.It has been postulated that chronic spinal degenerative disease coupled with adhesions between the Posterior Longitudinal Ligament (PLL) and the Dura are the pathomechanisms responsible [2].We report a case of a 63 year old Italian man, who presented to us with difficulty walking and urinating, with a sequestered disc at the level of L3-L4 which was found to be intradural disc herniation intraoperatively, he also had a stenosis secondary to a disc herniation at T11-T12 and T12-L1 that needed to be addressed.A 63 year old man, previously known to have hypertension, the patients history dates back to a couple of years before his presentation when he had leg pain that was successfully treated with a discectomy at the L5-S1 level.He was doing well till a couple of months before presenting to us when he was having progressively increasing back pain and right thigh numbness and pain and a couple of days prior to presentation he started having difficulty with urination.On examination he had numbness along the L3 right distribution, and he had right L3 radiculopathy, with ...

show abstract

“…Intradural disc herniation is rare condition and comprises 0.27% of all disc herniations 5,7) . In 92% of cases, intradural disc herniations occur in the lumbar region and the most affected site is the L4-5 (55%), followed by L3-4 (16%), and L5-S1 (10%) 3,7) .…”

Section: Discussionmentioning

confidence: 99%

“…Intradural lumbar disc herniation (ILDH) is rare and the incidence is reported as 0.04-0.33% of lumbar disc herniations 4,5) . Although the pathogenesis of intradural disc herniation is not certain, adhesion between the dura mater and posterior longitudinal ligament (PLL) has been accepted as a predisposing factor [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Intradural Lumbar Disc Herniations Associated with Epidural Adhesion : Report of Two Cases

Han

Jin

2009

J Korean Neurosurg Soc

View full text Add to dashboard Cite

J Korean Neurosurg Soc 46 : [168][169][170][171] 2009 Intradural lumbar disc herniation (ILDH) is rare. In this report, authors present 2 cases of ILDHs associated with severe adhesion between the dural sac and posterior longitudinal ligament. In a 40-year-old man, ILDH occurred in association with epidural adhesion due to ossification of the posterior longitudinal ligament (OPLL). In other 31-year-old man, ILDH occurred in presence of epidural adhesion due to previous spine surgery.

show abstract

Intradural lumbar disc herniation: report of two cases

Cited by 48 publications

References 16 publications

Intradural disc herniation - a case report

Intradural disc herniation - a case report

Intradural Lumbar Disc Herniation Associated with Degenerative Spine Disease

Intradural Lumbar Disc Herniations Associated with Epidural Adhesion : Report of Two Cases

Contact Info

Product

Resources

About