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An Unusual Case of Transdural Herniation of a Lumbar Intervertebral Disc: Diagnostic and Surgical Challenges.
World Neurosurg. 2019 Aug; 128:385-389.WN

Abstract

BACKGROUND

Intradural lumbar disc herniation is rare, with an incidence of 0.3%-1%, but has been well reported in the literature. Transdural migration of the disc penetrating both ventral and dorsal dura is extremely rare, and there is a dearth of literature in the pathophysiology and surgical management of transdural herniation. Lack of knowledge on this type of presentation can cause intraoperative surprises and inadvertent cauda equina root injuries and lead to prolonged operative time. We report 1 such case, describe our surgical experience, and discuss the pathological mechanisms and signs.

CASE DESCRIPTION

A 30-year-old woman presented to outpatient clinic with chronic cauda equina syndrome due to massive L4-L5 disc herniation. L4-L5 decompression and transforaminal lumbar interbody fusion were planned. Unexpectedly, however, surgery revealed a transdural herniation, which was effectively managed with laminectomy, extension of durotomy, discectomy, repair of both dorsal and ventral dura, and interbody fusion, but at the expense of prolonged surgical time.

CONCLUSIONS

Transdural herniation of a lumbar disc is very rare presentation. It can be effectively managed with laminectomy, extension of durotomy, discectomy and repair of both dorsal and ventral dura. It can be diagnosed by magnetic resonance imaging preoperatively only if read with suspicion of such presentation.

Authors+Show Affiliations

Spine Unit, Indian Spinal Injuries Centre, New Delhi, India. Electronic address: drashokreddy@gmail.com.Spine Unit, Indian Spinal Injuries Centre, New Delhi, India.Spine Unit, Indian Spinal Injuries Centre, New Delhi, India.Department of Neurosurgery, Indian Spinal Injuries Centre, New Delhi, India.Spine Unit, Indian Spinal Injuries Centre, New Delhi, India.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31121367

Citation

Pedaballe, Ashok Reddy, et al. "An Unusual Case of Transdural Herniation of a Lumbar Intervertebral Disc: Diagnostic and Surgical Challenges." World Neurosurgery, vol. 128, 2019, pp. 385-389.
Pedaballe AR, Mallepally AR, Tandon V, et al. An Unusual Case of Transdural Herniation of a Lumbar Intervertebral Disc: Diagnostic and Surgical Challenges. World Neurosurg. 2019;128:385-389.
Pedaballe, A. R., Mallepally, A. R., Tandon, V., Sharma, A., & Chhabra, H. S. (2019). An Unusual Case of Transdural Herniation of a Lumbar Intervertebral Disc: Diagnostic and Surgical Challenges. World Neurosurgery, 128, 385-389. https://doi.org/10.1016/j.wneu.2019.05.103
Pedaballe AR, et al. An Unusual Case of Transdural Herniation of a Lumbar Intervertebral Disc: Diagnostic and Surgical Challenges. World Neurosurg. 2019;128:385-389. PubMed PMID: 31121367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Unusual Case of Transdural Herniation of a Lumbar Intervertebral Disc: Diagnostic and Surgical Challenges. AU - Pedaballe,Ashok Reddy, AU - Mallepally,Abhinandan R, AU - Tandon,Vikas, AU - Sharma,Arun, AU - Chhabra,Harvinder S, Y1 - 2019/05/20/ PY - 2019/02/21/received PY - 2019/05/10/revised PY - 2019/05/11/accepted PY - 2019/5/24/pubmed PY - 2020/1/21/medline PY - 2019/5/24/entrez KW - Discectomy KW - Durotomy KW - Intradural herniation KW - Lumbar spine KW - Transdural herniation SP - 385 EP - 389 JF - World neurosurgery JO - World Neurosurg VL - 128 N2 - BACKGROUND: Intradural lumbar disc herniation is rare, with an incidence of 0.3%-1%, but has been well reported in the literature. Transdural migration of the disc penetrating both ventral and dorsal dura is extremely rare, and there is a dearth of literature in the pathophysiology and surgical management of transdural herniation. Lack of knowledge on this type of presentation can cause intraoperative surprises and inadvertent cauda equina root injuries and lead to prolonged operative time. We report 1 such case, describe our surgical experience, and discuss the pathological mechanisms and signs. CASE DESCRIPTION: A 30-year-old woman presented to outpatient clinic with chronic cauda equina syndrome due to massive L4-L5 disc herniation. L4-L5 decompression and transforaminal lumbar interbody fusion were planned. Unexpectedly, however, surgery revealed a transdural herniation, which was effectively managed with laminectomy, extension of durotomy, discectomy, repair of both dorsal and ventral dura, and interbody fusion, but at the expense of prolonged surgical time. CONCLUSIONS: Transdural herniation of a lumbar disc is very rare presentation. It can be effectively managed with laminectomy, extension of durotomy, discectomy and repair of both dorsal and ventral dura. It can be diagnosed by magnetic resonance imaging preoperatively only if read with suspicion of such presentation. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31121367/An_Unusual_Case_of_Transdural_Herniation_of_a_Lumbar_Intervertebral_Disc:_Diagnostic_and_Surgical_Challenges_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)31377-4 DB - PRIME DP - Unbound Medicine ER -