Intradural Lumbar Disc Herniation: A Case Report and Literature Review

Chao-Yuan Ge, Ding-Jun Hao, Liang Yan, Le-Qun Shan, Qin-Peng Zhao, Bao-Rong He, Hao Hui Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of ChinaCorrespondence: Ding-Jun HaoDepartment of Spine Surgery,...

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Autores principales:	Ge CY, Hao DJ, Yan L, Shan LQ, Zhao QP, He BR, Hui H
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	spine aging population discectomy decompression fixation fusion Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/bc7b2518f7254685a544b5c2371088e6
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spelling	oai:doaj.org-article:bc7b2518f7254685a544b5c2371088e62021-12-02T06:02:57ZIntradural Lumbar Disc Herniation: A Case Report and Literature Review1178-1998https://doaj.org/article/bc7b2518f7254685a544b5c2371088e62019-12-01T00:00:00Zhttps://www.dovepress.com/intradural-lumbar-disc-herniation-a-case-report-and-literature-review-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Chao-Yuan Ge, Ding-Jun Hao, Liang Yan, Le-Qun Shan, Qin-Peng Zhao, Bao-Rong He, Hao Hui Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of ChinaCorrespondence: Ding-Jun HaoDepartment of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, No. 555 Friendship East Road, Beilin District, Xi’an 710054, Shaanxi Province, People’s Republic of ChinaTel/Fax +86-29-87894724Email haodingjunspine@126.comBackground: 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.Keywords: spine, aging population, discectomy, decompression, fixation, fusionGe CYHao DJYan LShan LQZhao QPHe BRHui HDove Medical Pressarticlespineaging populationdiscectomydecompressionfixationfusionGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 2295-2299 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	spine aging population discectomy decompression fixation fusion Geriatrics RC952-954.6
spellingShingle	spine aging population discectomy decompression fixation fusion Geriatrics RC952-954.6 Ge CY Hao DJ Yan L Shan LQ Zhao QP He BR Hui H Intradural Lumbar Disc Herniation: A Case Report and Literature Review
description	Chao-Yuan Ge, Ding-Jun Hao, Liang Yan, Le-Qun Shan, Qin-Peng Zhao, Bao-Rong He, Hao Hui Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of ChinaCorrespondence: Ding-Jun HaoDepartment of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, No. 555 Friendship East Road, Beilin District, Xi’an 710054, Shaanxi Province, People’s Republic of ChinaTel/Fax +86-29-87894724Email haodingjunspine@126.comBackground: 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.Keywords: spine, aging population, discectomy, decompression, fixation, fusion
format	article
author	Ge CY Hao DJ Yan L Shan LQ Zhao QP He BR Hui H
author_facet	Ge CY Hao DJ Yan L Shan LQ Zhao QP He BR Hui H
author_sort	Ge CY
title	Intradural Lumbar Disc Herniation: A Case Report and Literature Review
title_short	Intradural Lumbar Disc Herniation: A Case Report and Literature Review
title_full	Intradural Lumbar Disc Herniation: A Case Report and Literature Review
title_fullStr	Intradural Lumbar Disc Herniation: A Case Report and Literature Review
title_full_unstemmed	Intradural Lumbar Disc Herniation: A Case Report and Literature Review
title_sort	intradural lumbar disc herniation: a case report and literature review
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/bc7b2518f7254685a544b5c2371088e6
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Intradural Lumbar Disc Herniation: A Case Report and Literature Review

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