Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration

Tempel, Zachary J.; Zhu, Xiao; McDowell, Michael M.; Agarwal, Nitin; Monaco, Edward A.

doi:10.1016/j.wneu.2016.06.024

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Furthermore, there are numerous case reports of herniated fragments that become sequestered in the dural sac and migrate cranially. 22,23 A classification system proposed by Mut et al breaks down ILDH into two types based on the anatomical location of the herniation. 24 Type A is described as occurring in the main column of the dural sac whereas type B herniations are at the lateral exit of the nerve root.…”

Section: Diagnosis and Imagingmentioning

confidence: 99%

Intradural lumbar disc herniation: illustrative case

Ihejirika-Lomedico

Tong

Patel

et al. 2021

Journal of Neurosurgery: Case Lessons

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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.

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Section: Diagnosis and Imagingmentioning

confidence: 99%

Intradural lumbar disc herniation: illustrative case

Ihejirika-Lomedico

Tong

Patel

et al. 2021

Journal of Neurosurgery: Case Lessons

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“… 4 , 19 This erosion coupled with the mechanical squeezing force exerted by herniated disc fragments causes thinning of the adhered local dural sac 18 and its eventual rupture, resulting in the entry of free disc fragments into the subdural space where they compress and stimulate the cauda equina nerve. 6 , 20 At this point, patients with chronic intermittent pain may experience acute and more serious neurologic symptoms. 16 Our patient had a history of chronic lower back and leg pain resulting from a lumbar sprain that progressed to serious acute pain, which was highly suspected to be caused by disc degeneration.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Patients with chronic lower back pain often have upper lumbar IDH caused by acute lumbar sprain from heavy manual work. 6,7 Preoperative radiographic findings can be misinterpreted as intradural tumors, cysts, or metastases, 8 making definitive preoperative diagnoses difficult. 5 Most cases rely on surgery for the final diagnosis, but surgical management of IDH-especially in the upper lumbar region-is also challenging, with a high risk of nerve injury.…”

Section: Introductionmentioning

confidence: 99%

Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis

Chen¹,

Ni²,

Xue³

et al. 2021

JPR

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Background: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre-and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms. Case Description: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient's pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up. Conclusion:Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.

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Sequestrated Lumbar Disk Herniations

Akhaddar

2023

Atlas of Sciatica

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Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration

Cited by 6 publications

References 10 publications

Intradural lumbar disc herniation: illustrative case

Intradural lumbar disc herniation: illustrative case

Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis

Sequestrated Lumbar Disk Herniations

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