Intradural cervical herniated nucleus pulposus presentation and management: a case report
Tzu Chuan Yen1, John R Worley1, Devin St Clair1
1Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA.
AME Case Reports
|July 26, 2023
Summary
Intradural disc herniations (IDH) are rare cervical spine conditions. Early MRI diagnosis and anterior surgical decompression can improve outcomes for patients with Brown-Sequard syndrome (BSS).
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Intradural disc herniations (IDH) are uncommon spinal conditions.
- Cervical IDH can be associated with Brown-Sequard syndrome (BSS).
- Pre-operative identification of IDH is crucial for surgical planning.
Observation:
- A 42-year-old male presented with atraumatic neurological deficits.
- Cervical MRI revealed a C6-7 herniated nucleus pulposus with dural protrusion.
- Clinical presentation was consistent with an incomplete spinal cord injury, likely BSS.
Findings:
- Surgical exploration confirmed an intradural disc fragment.
- Anterior cervical discectomy and fusion were performed.
- Post-operatively, the patient showed improvement in upper extremity symptoms.
Implications:
- Advanced imaging like MRI aids in diagnosing cervical IDH.
- Anterior surgical approaches are effective for IDH removal and dural repair.
- Prompt surgical intervention can lead to neurological recovery.
Related Concept Videos
01:29Herniated Intervertebral Disc l: Introduction
Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...
01:27Degenerative Disc Disease I: Introduction
Degenerative disc disease is a chronic condition in which intervertebral discs gradually lose structure and function. It is not infectious or autoimmune; rather, it results from age-related biochemical and mechanical changes, influenced by genetic, metabolic, and environmental factors.Structure and Function of DiscsThe spine contains 23 intervertebral discs that absorb load, distribute forces, maintain spacing, and allow flexibility. Each disc consists of a nucleus pulposus, a gel-like core...
01:23Degenerative Disc Disease ll: Pathophysiology
The symptoms of degenerative disc disease arise from a combination of mechanical compression, vascular compromise, and biochemical inflammation, which together disrupt nerve function and produce pain.Mechanical CompressionDisc degeneration reduces height and elasticity, predisposing to herniation of the nucleus pulposus, a major cause of radicular pain. Herniations may be protrusion (bulging with intact annulus), extrusion (nucleus extends beyond disc but remains connected), or sequestration...