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Intradural Lumbar Disc Herniation: A Case Report and Literature Review.
Clin Interv Aging. 2019; 14:2295-2299.CI

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-year-old 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.

Authors+Show Affiliations

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

31920293

Citation

Ge, Chao-Yuan, et al. "Intradural Lumbar Disc Herniation: a Case Report and Literature Review." Clinical Interventions in Aging, vol. 14, 2019, pp. 2295-2299.
Ge CY, Hao DJ, Yan L, et al. Intradural Lumbar Disc Herniation: A Case Report and Literature Review. Clin Interv Aging. 2019;14:2295-2299.
Ge, C. Y., Hao, D. J., Yan, L., Shan, L. Q., Zhao, Q. P., He, B. R., & Hui, H. (2019). Intradural Lumbar Disc Herniation: A Case Report and Literature Review. Clinical Interventions in Aging, 14, 2295-2299. https://doi.org/10.2147/CIA.S228717
Ge CY, et al. Intradural Lumbar Disc Herniation: a Case Report and Literature Review. Clin Interv Aging. 2019;14:2295-2299. PubMed PMID: 31920293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intradural Lumbar Disc Herniation: A Case Report and Literature Review. AU - Ge,Chao-Yuan, AU - Hao,Ding-Jun, AU - Yan,Liang, AU - Shan,Le-Qun, AU - Zhao,Qin-Peng, AU - He,Bao-Rong, AU - Hui,Hao, Y1 - 2019/12/23/ PY - 2019/08/29/received PY - 2019/12/07/accepted PY - 2020/1/11/entrez PY - 2020/1/11/pubmed PY - 2020/4/17/medline KW - aging population KW - decompression KW - discectomy KW - fixation KW - fusion KW - spine SP - 2295 EP - 2299 JF - Clinical interventions in aging JO - Clin Interv Aging VL - 14 N2 - 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-year-old 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. SN - 1178-1998 UR - https://www.unboundmedicine.com/medline/citation/31920293/Intradural_Lumbar_Disc_Herniation:_A_Case_Report_and_Literature_Review_ L2 - https://dx.doi.org/10.2147/CIA.S228717 DB - PRIME DP - Unbound Medicine ER -