Unexpected Intradural Lumbar Disk Herniation Found During Transforaminal Endoscopic Surgery

Moon, Sung-Jun; Han, Moon-Soo; Lee, Gwang-Jun; Lee, Seul-Kee; Moon, Bong Ju; Lee, Jung-Kil

doi:10.1016/j.wneu.2019.11.121

Cited by 8 publications

(12 citation statements)

References 12 publications

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“…11 The exact pathophysiologic mechanism is unclear, but congenital or acquired dense adhesions between the PLL and ventral dural sac are thought to be involved. 11,12 To our knowledge, IDH is primarily influenced by acquired predisposing factors such as chronic inflammation, degenerative disease, iatrogenic conditions, trauma, local infection, and hemorrhage. [13][14][15] These etiopathogenic factors can result in local adhesions and facilitate migration of…”

Section: Discussionmentioning

confidence: 99%

“…When patients manifest severe neurologic symptoms and IDH is highly suspected based on radiologic evidence, immediate surgical intervention should be considered as the first-line treatment. 11 The surgical procedure involves careful exploration and meticulous dissection to avoid neurologic injury. 9 Although intradural herniation has been examined by transforaminal posterolateral endoscopy, the main surgical approach is durotomy.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Some surgeons have used hemostatic material or autogenous fascial or fat grafts instead of continuous sutures to close the ventral defect without CSF leakage or other complications. 9,11,25 Spinal fusion and internal fixation are also recommended to stabilize the local intervertebral space and avoid secondary disc herniation. 9,32 Compared to previous reports, the novelty of the present case study is that it provides strategies for preoperative imaging diagnosis of upper IDH and a paradigm for the surgical diagnosis of this condition including selection of the surgical approach and intraoperative examination.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Chen¹,

Ni²,

Xue³

et al. 2021

JPR

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“…The difference between the two groups was statistically significant ( P < 0.05). The application of a lumbar discoscope can reduce various complications during and after surgery[ 12 , 13 ]. The reason for this is that the dorsal branch of the spinal nerve dominates the paravertebral muscles and lumbar spine joints, and the lumbar spine joint is dominated by more than two spinal cord segments[ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation

Pang¹,

Tan²,

Chen³

et al. 2020

WJCC

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BACKGROUND Lumbar disc herniation is a common disease. Endoscopic treatment may have more advantages than traditional surgery. AIM To compare the clinical efficacy and safety of microendoscopic discectomy (MED) and open discectomy with lamina nucleus enucleation in the treatment of single-segment lumbar intervertebral disc herniation. METHODS Ninety-six patients who were operated at our hospital were selected for this study. Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group. The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy. Surgical effects were compared between the two groups. RESULTS In terms of surgical indicators, the observation group had a longer operation time, shorter postoperative bedtime and hospital stay, less intraoperative blood loss, and smaller incision length than the control group ( P < 0.05). The excellent recovery rate did not differ significantly between the observation group (93.75%) and the control group (91.67%). Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d, 3 d, 1 mo, and 6 mo after surgery ( P < 0.05). The incidence of complications was significantly lower in the observation group than in the control group (6.25% vs 22.92%, P < 0.05). CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation, but MED is associated with less trauma, less bleeding, and a lower incidence of complications.

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Intradural Lumbar Disk Herniations

Akhaddar

2023

Atlas of Sciatica

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Unexpected Intradural Lumbar Disk Herniation Found During Transforaminal Endoscopic Surgery

Cited by 8 publications

References 12 publications

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

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

Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation

Intradural Lumbar Disk Herniations

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