Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration
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Published on: August 7, 2018
Zachary Tempel1, Xiao Zhu1, Michael M McDowell1
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Background:
Intrathecal disc herniation is a rare but serious condition that has the potential to generate devastating neurologic deficits. We present a case of a 56-year-old man who developed cauda equina syndrome after several episodes of severe Valsalva maneuver.
Case Description:
The patient was found to have developed subacute urinary retention and leg weakness. Magnetic resonance imaging findings were concerning for an unusual-appearing lesion extending cranially at L2-3. Urgent decompression via an L2 laminectomy, exploration, and subsequent discectomy was performed. The patient recovered exceptionally well, regaining bladder function and ultimately being able to ambulate without assistance.
Conclusions:
Cranially extending intrathecal disc herniations are a rare phenomenon and exceptionally uncommon above L3. The clinician should have a high level of suspicion for herniation when looking at the clinical and historical information consistent with such a diagnosis even in the presence of ambiguous imaging findings.
