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Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration
Zachary Tempel1, Xiao Zhu1, Michael M McDowell1
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
World Neurosurgery
|June 19, 2016
Summary
Intrathecal disc herniation is a rare cause of cauda equina syndrome. Prompt surgical decompression led to significant recovery in a patient with a cranially extending lumbar disc herniation.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neurology
Background:
- Intrathecal disc herniation is a rare condition with severe neurological consequences.
- Cauda equina syndrome can result from intrathecal disc herniation, often triggered by Valsalva maneuvers.
Observation:
- A 56-year-old male presented with subacute urinary retention and leg weakness.
- MRI revealed an unusual lesion at L2-3, suggestive of a cranially extending intrathecal disc herniation.
Findings:
- Surgical decompression via L2 laminectomy and discectomy was performed.
- The patient experienced a remarkable recovery, regaining bladder function and ambulation.
Implications:
- Cranially extending intrathecal disc herniations are exceptionally rare, particularly above L3.
- High clinical suspicion is crucial for diagnosing intrathecal disc herniation, even with ambiguous imaging.
- Early surgical intervention is key for favorable outcomes in cauda equina syndrome due to intrathecal disc herniation.
