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Intradural lumbar disc herniation: illustrative case.

Rivka Chinyere Ihejirika1, Yixuan Tong1, Karan Patel1

  • 1Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York.

Journal of Neurosurgery. Case Lessons
|September 5, 2022
PubMed
Summary

Intradural lumbar disc herniations (ILDHs) are rare, often occurring after spine surgery. Prompt identification and surgical treatment involving laminectomy and durotomy are crucial for managing this condition.

Keywords:
PLL = posterior longitudinal ligamentCSF = cerebrospinal fluidILDHILDH = intradural lumbar disc herniationLDH = lumbar disc herniationMRI = magnetic resonance imagingcauda equina syndromeintradural lumbar disc herniationspine surgery

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Area of Science:

  • Neurosurgery
  • Spinal Surgery

Background:

  • Intradural lumbar disc herniations (ILDHs) are rare, comprising <0.4% of all disc herniations.
  • Often a complication of prior lumbar spine surgery, potentially due to dural defects or adhesions.

Observation:

  • A 67-year-old patient with prior laminectomy presented with persistent low back and leg pain.
  • MRI revealed a large ILDH; surgical intervention included fusion, durotomy, ILDH removal, and dural repair.

Findings:

  • A ventral dural defect was identified and repaired during surgery.
  • Laminectomy with dorsal durotomy is the established treatment for ILDH.

Implications:

  • Understanding ILDH presentation is vital for timely diagnosis and effective management.
  • This case highlights surgical considerations for rare intradural disc pathologies.