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

Abstract

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.

Medical Communication Services after Traumatic Spinal Cord Injury

“…Essentially, all patients showed functional recovery. Phang et al introduced a case of eleven patients who were treated by laminectomy alone [ 12 – 14 ]. In contrast, he studied the results of another ten patients who underwent duroplasty in addition to laminectomy.…”

“…Esfahani et al presented a case report of a 60-year-old man laminectomy performed to treat L4 fracture; no hematoma was encountered, but after using ultrasound intraoperatively, a hematoma was detected and removed by durotomy; luckily, patient ASIA grade improved from D to E [ 21 ]. Ge et al used ultrasound intraoperatively for a 68-year-old man complaining of lower back pain because of herniated disc, but ultrasound showed a mass that was treated by durotomy and he became normal after three months [ 12 ]. Koyanagi et al presented four cases with good prognosis after myelotomy, but all the cases were acute SCI [ 22 ].…”

“…It also shows blood flow pulse, which can indicate blood vessel occlusion if the pulse is high/low [ 34 ]. Visual inspection of an acutely injured spinal cord can reveal some attributes that are not visible on the initial MRI, and the diameter of the cord can be seen on ultrasonography [ 12 , 29 ]. To prevent further pressure and injury after the operation, place the patient in a lateral position.…”

Intradural disc herniation of L2/3: A case report and literature review

“…The incidence of IDH in the lumbar region is approximately 0.26–0.3% of all lumbar disc herniations. Of these, 92% were found in the lumbar region, mostly at the L4/5 level (55%) (L3/L4 [16%], L5/S1 [10%]) and are rarely seen at the L1/L2 and L2/L3 levels [1] , [2] , [3] , [4] . The peak incidence of IDH occurs in the fifth to sixth decades of life and is four times more common in men than in women [5] .…”

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

“…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.…”