Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report

Area of Science:

• Neurosurgery
• Spinal Surgery
• Radiology

Background:

• Intradural disc herniation (IDH) is a rare spinal condition with unclear pathogenesis.
• The L4-L5 level is the most common site for IDH, typically affecting individuals aged 50-60.
• Preoperative diagnosis of IDH is challenging despite advanced imaging like MRI.

Observation:

• A 58-year-old male presented with chronic low back pain, bilateral leg radiculopathy, and recent onset of cauda equina syndrome (urinary/defecation dysfunction).
• MRI revealed a large L4-L5 disc herniation with a stalk extending intradurally, causing significant spinal canal compression.
• The patient exhibited decreased muscle strength in both legs.

Findings:

• Surgical exploration revealed a dural perforation with the herniated disc predominantly located within the intradural space.
• A bilateral hemilaminectomy and transforaminal lumbar interbody fusion were performed.
• Complete tumor removal was achieved, and the dural defect was repaired.

Implications:

• Surgical intervention is the definitive treatment for intradural disc herniations.
• Prompt surgical management can lead to complete recovery from radiculopathy and cauda equina syndrome.
• Intraoperative findings and histopathology are crucial for definitive diagnosis of IDH.