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Transforaminal Endoscopic Excision of Intradural Lumbar Disk Herniation and Dural Repair.
World Neurosurg. 2018 Nov; 119:163-167.WN

Abstract

BACKGROUND

Intradural disk herniation is a rare entity with <0.3%-1% of all disk herniations and at an L2-L3 level even rarer. The dural defects repairs on ventral aspect are technically challenging and may not be possible after durotomy, so many authors have placed fascia, muscle, or plugging by the hemostatic material. The surgical treatment of intradural disk herniation is usually posterior open surgery with formal durotomy to remove the disk fragments with good to fair results. Poorer outcome occurs in late-presenting cases.

CASE REPORT

We report on a 78-year-old man who presented with spontaneous low back pain and bilateral buttock pain aggravated for 1 month with severe walking difficulty without bowel and bladder symptoms. Magnetic resonance imaging revealed disk herniation at the L2-L3 level. He underwent a transforaminal endoscopic removal of intradural disk fragments via the original rent in the anterolateral aspect of the dura, and sealing was performed with dural patch and Gelfoam without any lumbar drain. The patient's symptom significantly improved postoperatively with muscle power improved to grade 5 on day 1 with no cerebrospinal fluid leakage, and he was mobilized with a lumbar orthosis on the first postoperative day. Postoperative and at 6-month follow-up, magnetic resonance imaging revealed adequate decompression and successful sealing of the ventral dural defect.

CONCLUSIONS

To our knowledge, this is the first case of transforaminal endoscopic treatment of intradural disk herniation at an L2-L3 level in which good clinical outcomes were obtained and maintained until recent follow-up of 8 months.

Authors+Show Affiliations

Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea.Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Kathmandu Medical College, Kathmandu, Nepal.Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea. Electronic address: no1.nitinadsul@gmail.com.Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Republic of Korea.Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea.Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Republic of Korea.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30092470

Citation

Kim, Hyeun Sung, et al. "Transforaminal Endoscopic Excision of Intradural Lumbar Disk Herniation and Dural Repair." World Neurosurgery, vol. 119, 2018, pp. 163-167.
Kim HS, Pradhan RL, Adsul N, et al. Transforaminal Endoscopic Excision of Intradural Lumbar Disk Herniation and Dural Repair. World Neurosurg. 2018;119:163-167.
Kim, H. S., Pradhan, R. L., Adsul, N., Jang, J. S., Jang, I. T., & Oh, S. H. (2018). Transforaminal Endoscopic Excision of Intradural Lumbar Disk Herniation and Dural Repair. World Neurosurgery, 119, 163-167. https://doi.org/10.1016/j.wneu.2018.07.244
Kim HS, et al. Transforaminal Endoscopic Excision of Intradural Lumbar Disk Herniation and Dural Repair. World Neurosurg. 2018;119:163-167. PubMed PMID: 30092470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transforaminal Endoscopic Excision of Intradural Lumbar Disk Herniation and Dural Repair. AU - Kim,Hyeun Sung, AU - Pradhan,Rabindra L, AU - Adsul,Nitin, AU - Jang,Jee-Soo, AU - Jang,Il-Tae, AU - Oh,Seong-Hoon, Y1 - 2018/08/06/ PY - 2018/06/23/received PY - 2018/07/25/revised PY - 2018/07/26/accepted PY - 2018/8/10/pubmed PY - 2018/12/12/medline PY - 2018/8/10/entrez KW - Endoscopic dural repair technique KW - Endoscopic spine surgery KW - Intradural disk herniation SP - 163 EP - 167 JF - World neurosurgery JO - World Neurosurg VL - 119 N2 - BACKGROUND: Intradural disk herniation is a rare entity with <0.3%-1% of all disk herniations and at an L2-L3 level even rarer. The dural defects repairs on ventral aspect are technically challenging and may not be possible after durotomy, so many authors have placed fascia, muscle, or plugging by the hemostatic material. The surgical treatment of intradural disk herniation is usually posterior open surgery with formal durotomy to remove the disk fragments with good to fair results. Poorer outcome occurs in late-presenting cases. CASE REPORT: We report on a 78-year-old man who presented with spontaneous low back pain and bilateral buttock pain aggravated for 1 month with severe walking difficulty without bowel and bladder symptoms. Magnetic resonance imaging revealed disk herniation at the L2-L3 level. He underwent a transforaminal endoscopic removal of intradural disk fragments via the original rent in the anterolateral aspect of the dura, and sealing was performed with dural patch and Gelfoam without any lumbar drain. The patient's symptom significantly improved postoperatively with muscle power improved to grade 5 on day 1 with no cerebrospinal fluid leakage, and he was mobilized with a lumbar orthosis on the first postoperative day. Postoperative and at 6-month follow-up, magnetic resonance imaging revealed adequate decompression and successful sealing of the ventral dural defect. CONCLUSIONS: To our knowledge, this is the first case of transforaminal endoscopic treatment of intradural disk herniation at an L2-L3 level in which good clinical outcomes were obtained and maintained until recent follow-up of 8 months. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30092470/Transforaminal_Endoscopic_Excision_of_Intradural_Lumbar_Disk_Herniation_and_Dural_Repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)31724-8 DB - PRIME DP - Unbound Medicine ER -