Journal List > J Korean Soc Spine Surg > v.21(3) > 1076027

Lee, Seo, Park, and Oh: Sequestrated Intradural Disc Herniation Around Couns Medullaris - A Case Report -

Abstract

Study Design

A case report.

Objectives

To report a rare case of intradural disc herniation (IDH) around conus medullaris.

Summary of Literature Review

IDH is rare with an incidence of less than 1% of all lumbar disc herniations. It is important to differentiate IDH from other condition with accurate diagnosis and subsequent surgical treatment. IDH has a higher risk of neurologic deficit, like conus medullaris syndrome and cauda equina syndrome.

Materials and Methods

A 62 year-old male was affected by lumbar back pain radiating to the anterolateral aspect of the right thigh for 5 days. MRI showed a mass that existed on the anterior portion of the conus medullaris. We performed partial laminectomy at the L1-L2level. The mass located anteriorly in the intradural space was eliminated after durotomy by a posterior approach.

Results

We confirmed the IDH for histopathology.

Conclusions

IDH usually needs accurate differential diagnosis. Preoperative MRI scans are necessary to differentiate IDH from other intradural lesions. The confirmative diagnosis can be done only in the operative field.

REFERENCES

1. Epstein NE, Syrquin MS, Epstein JA, Decker RE. Intradural disc herniations in the cervical, thoracic, and lumbar spine: report of three cases and review of the literature. J Spinal Disord. 1990; 3:396–403.
2. Kataoka O, Nishibayashi Y, Sho T. Intradural lumbar disc herniation. Report of three cases with a review of the literature. Spine (Phila Pa 1976). 1989; 14:529–33.
3. Connolly PJ, Rosenbaum AE, Sacks T, Kopacz KJ. In-complete intradural lumbar disk herniation. Orthopedics. 1997; 20:977–9.
crossref
4. Eisenberg RA, Bremer AM, Northup HM. Intradural herniated cervical disk: a case report and review of the literature. AJNR Am J Neuroradiol. 1986; 7:492–4.
5. Blikra G. Intradural herniated lumbar disc. J Neurosurg. 1969; 31:676–9.
crossref
6. Yildizhan A, Pasaoglu A, Okten T, Ekinci N, Aycan K, Aral O. Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment. Acta Neurochir (Wien). 1991; 110:160–5.
crossref
7. Liu CC, Huang CT, Lin CM, Liu KN. Intradural disc herniation at L5 level mimicking an intradural spinal tumor. Eur Spine J. 2011; 20(Suppl 2):S326–9.
crossref
8. Hidalgo-Ovejero AM, Garcia-Mata S, Gozzi-Vallejo S, Izco-Cabezon T, Martinez-Morentin J, Martinez-Grande M. Intradural disc herniation and epidural gas: something more than a casual association? Spine (Phila Pa 1976). 2004; 29:E463–7.
crossref
9. Hida K, Iwasaki Y, Abe H, Shimazaki M, Matsuzaki T. Magnetic resonance imaging of intradural lumbar disc herniation. J Clin Neurosci. 1999; 6:345–7.
crossref
10. Tali ET, Gultekin S. Spinal infections. Eur Radiol. 2005; 15:599–607.
crossref

Fig. 1.
Preoperative AP (A) and lateral (B) x-rays. Intervertebral disc space of L1-2 is narrower than other intervertebral disc spaces.
jkss-21-134f1.tif
Fig. 2.
T1- and T2-weighted images in non-contrast sagittal and axial MRI (T1WI) (A, B). Gadolinium-enhanced T1-weighted MRI shows ring enhancement of the mass(C).
jkss-21-134f2.tif
Fig. 3.
Intraoperative clinical photo shows intradural egg-shaped mass after dural incision(A, B).
jkss-21-134f3.tif
Fig. 4.
H-E stained histologic findings show degenerative disc. (A) original magnification x 40, (B) original magnification x 200.
jkss-21-134f4.tif
TOOLS
Similar articles