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

Han, Inho; Kh, Kim; Jin, Byung-Ho

doi:10.3340/jkns.2009.46.2.168

Cited by 28 publications

(31 citation statements)

References 7 publications

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“…Other predisposing conditions stated in the literature are congenital reduction of dural thickness, vertebral canal congenital stenosis [1], and previous surgeries [10]. All five cases reported in this paper presented adhesions between the dural sac and the PLL, and one case had previous surgery at the same level of the IDH.…”

Section: Discussionmentioning

confidence: 87%

“…Such adhesions occur more often in L4-L5 space, which justifies a higher incidence of intradural disc herniations at this level, being more prevalent in patients with history of previous lumbar pain [6]. One believes that patients with degenerative disc pathologies would present a chronic inflammatory process, which would favor the occurrence of these adhesions, leading to erosions on the adjacent dural sheath [7][8][9][10][11]. Nevertheless, IDH can have congenital origin: such adhesions have also been found in stillborn autopsies [4,7].…”

Section: Discussionmentioning

confidence: 99%

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Intradural lumbar disc herniation: report of five cases with literature review

Ducati

Silva²,

Brandão³

et al. 2012

Eur Spine J

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Introduction Intradural lumbar disc herniations are uncommon presentations of a relatively frequent pathology, representing less than 1% of all lumbar disc hernias. They show specific features concerning their clinical diagnosis, with a higher incidence of cauda equina syndrome, and their surgical treatment requires a transdural approach. Methods In this article, we describe five cases of this pathology and review the literature as well as some considerations about the difficulties in the preoperative diagnostic issues and the surgical technique. Conclusion We concluded that for intradural disc herniations the diagnosis is mainly intraoperative, and the surgical technique has some special aspects.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Intradural lumbar disc herniation: report of five cases with literature review

Ducati

Silva²,

Brandão³

et al. 2012

Eur Spine J

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“…These dense adhesions may be congenital due to prenatal adhesion formation [17] or they are acquired and occur (1) spontaneously subsequent to degenerative disc disease with or without association to an ossification of the PLL [7] or they (2) develop after the previous spine surgery or trauma due to scar tissue formation within the epidural space [2,7,15].…”

Section: Discussionmentioning

confidence: 99%

“…Since the first report of an intradural sequester was presented by Dandy [4] in 1942, more than 140 cases have been reported in the literature [7].…”

Section: Introductionmentioning

confidence: 99%

Chronic dura erosion and intradural lumbar disc herniation: CT and MR imaging and intraoperative photographs of a transdural sequestrectomy

Floeth

Herdmann

2011

Eur Spine J

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Introduction A 47-year-old male with a history of recurrent low-back pain presented with acute left radiculopathy. Material and methods The CT and MR scans showed a severe osteochondrosis of the L4/5 segment, a broad protrusion of the disc annulus and extrusion of nucleus material into the spinal canal on the left side. Results The caudally dislocated sequester pieces were visualised intradurally and the intraoperative finding confirmed this rare pathology. After dorsal durotomy-free sequester material was found between the nerve rootlets within the subarachnoid space and altogether ten fragments were removed. Further transdural exploration visualised ventrally a round dura defect surrounded by a thickened arachnoid layer with enlarged veins as a sign of a chronic erosive process. Discussion Patients history, imaging and the intraoperative findings support the thesis, that chronic degenerative disc disease and adhesions between the posterior longitudinal ligament and the dura are the predisposing pathogenetic factors for an intradural disc herniation. Conclusion Intradural disc herniation is a rare condition and requires durotomy to remove the pathology. Therefore an actual high resolution MRI is mandatory in all cases of intraspinal space occupying lesions.

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“…Most of the authors reported that adhesion between the dura mater and posterior longitudinal ligament causing from previous spine surgery has been accepted as a predisposing factor [1]. Here we report an adult patient with IDLDH.…”

Section: Introductionmentioning

confidence: 86%

Intradural Lumbar Disc Herniation: A Rare Case

Bakar¹

2013

Ann Clin Anal Med

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Özet65 yaşında erkek hasta bel ve her iki bacakta ağrı, idrar-gayta yapamama, erektil disfonksiyon ile başvurdu. Lomber MRG tetkikinde T2 ağırlıklı görüntülerde L4-5 seviyesinde kanal içini dolduran ve posterior longitudinal ligament (PLL) devamlılığını bozan ekstrüde disk hernisi saptandı. Ameliyatta dural kese açıldığında granülasyonla örtülü disk fragmanları saptandı ve tamamen boşaltıldı. Ameliyat sonrası ağrıları geçen hastanın 3 ay sonrası kontrolünda idrar-gayta yapmasının tama yakın düzeldiği ve erektil disfonksiyonun ortadan kalktığı saptandı. Lomber MRG tetkikinde nüks yada psödomeningosel gelişimi saptanmadı. Bu olgudan da anlaşıldığı üzere MRG tetkikleri incelendiğinde iki durumun IDH şüphesini artırabi-leceği düşünülmüştür. Birinci nokta PLL devamlılığının olmaması, ikinci nokta ise herniye olmuş intervertebral diskin spinal kanala gaga şeklinde uzanım gösterme-sidir. Bu hastalarda prognozun herniye diskin tamamen boşaltılması ve semptomların süresi ve karakteri ile yakın ilişkili olduğu saptanmıştır. Anahtar KelimelerCauda Equina Sendromu; Intradural Disk; Durotomi Abstract A 65-year-old man was admitted with radiating pain in right leg and saddle type anaesthesia with urination, defecation and ejaculation problems. Spinal MRI revealed a disc fragment that hugely extruded towards central spinal channel with marked cranial migration at L4-5 level on the T2 weighted sagittal image. It also demonstrated abrupt loss of continuity of the posterior longitudinal ligament (PLL). Then, he was taken for surgery. After a durotomy was performed, two pieces of cartilagenous tissue were removed en bloc. Three months later, his urination, defecation, ejaculation returned to nearly normal; and postoperative MRI revealed that operative site was clean and there was no residual disc material. We would like to emphasis on two points of MR findings about which increase the suspicious for intradural extension of these disc fragments. The first point is abrupt loss of continuity of the posterior longitudinal ligament. The second point is a sharp beak-like appearance on T2 weighted axial imaging. Prognosis is related to complete removal of the herniated material, cleaning of the intervertebral space, duration and characterization of the symptomatology.

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

Cited by 28 publications

References 7 publications

Intradural lumbar disc herniation: report of five cases with literature review

Intradural lumbar disc herniation: report of five cases with literature review

Chronic dura erosion and intradural lumbar disc herniation: CT and MR imaging and intraoperative photographs of a transdural sequestrectomy

Intradural Lumbar Disc Herniation: A Rare Case

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