A Large L4/5 Intradural Disc Herniation (IDH): A Rare Case Report and Review of Literature

Intradural disc herniation is an uncommon presentation of degenerative spine disease. We present a rare case of a large intradural lumbar disc herniation (IDH), discuss its diagnostic challenges, and review current literature to highlight clinical features, radiologic findings, and surgical outcomes.

We present the case of a 39-year-old female with progressive radiculopathic low back pain unresponsive to conservative management, with an acute exacerbation of 1 week before presentation. MRI suggested a large L4-L5 disc herniation with possible intradural extension. She had a repeat surgery (intradural approach), and intraoperatively, a large intradural disc was seen displacing and compressing the cauda equina. The disc fragment was removed, and an expanded duroplasty was performed.

The patient had a significant postoperative neurological improvement, which was sustained after a 1-year follow-up period. Evidence of a large disc herniation on MRI makes it difficult to differentiate between IDH and disc extrusion. Surgical management offers good outcomes.