Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis

Herniating Intradural Disc at Lumbar L4-L5 Level: A Case Report

Prolapse of intervertebral disc is a common pathology seen in the neurosurgery field but intradural lumbar disc herniation is a rare entity encountered only during the surgical treatment of prolapse. We present a 30-year-old male who reported lower back pain radiating to the right lower limb for the last 2.5 years. The pain started after a brief history of weight lifting. There were no associated motor or sensory deficits. The magnetic resonance imaging of the lumbosacral spine showed prolapse of intervertebral disc at the level of lumbar L4-L5. The patient underwent laminectomy and intradural discectomy of L4-L5. Patient had a smooth post-operative recovery with no neurological deficits. A thorough radiological examination can aid in the pre-operative diagnosis of an intradural lumbar disc herniation.

Intradural lumbar disc herniation of L2-L3: A case report and literature review

Background

Intradural lumbar disc herniation (ILDH), especially upper lumbar intradural disc herniation, is a rare type of lumbar disc herniation (LDH). However, it may have severe and complex symptoms, causing serious impact on the patients. Additionally, it is difficult to be diagnosed with limited experience. Few studies on L2-L3 ILDH have been reported in the literature. This study presents such a case and reviews the incidence, etiology, symptoms, diagnosis and treatment of this disease, so as to provide guidance and experience for clinicians.

Case presentation

A 27-year-old male patient had a one-month history of severe lower back pain and left lower extremity weakness after lumbar sprain. He could not walk due to progressive symptoms. Physical examination revealed that straight leg raising and femoral nerve stretch tests on the left side were positive. Magnetic resonance imaging of lumbar showed an intradural disc protruding into the ventral dural sac at the L2-L3 level. He was diagnosed ILDH of L2-L3, finally. An urgent operation was performed to remove the intradural disc fragment. The patient's symptoms improved significantly, postoperatively. After eight months of follow-up, he returned to normal life with only slight lower back pain.

Conclusions

ILDH at the L2-L3 level is an extremely rare type of LDH. Its diagnosis often requires a combination of symptom, physical examination, and imaging examination due to no typical symptoms or imaging features. A detailed preoperative plan including the definition of the position, calcification, migration, and adhesion of intradural intervertebral discs to decrease the risk of surgery, prevent the occurrence of complications, and promote postoperative prognosis of patients.

Intradural Lumbar Disc Herniation: Updated Report of a Case with Literature Review

Intradural lumbar disc herniation is a rare complication of disc disease. The mechanism by which a herniated disc tears the dura matter remains unknown. The preoperative diagnosis of an intradural lumbar disc herniation is still difficult. We report our experience dealing with a case of intradural lumbar disc herniation at level L3/4 in a 34-year-old man. Based on current experience, we found that attachment of the ventral dura to the posterior longitudinal ligament can be a favorable factor indicating intradural lumbar disc herniation. One should pay attention to those with cauda equina syndrome, as it can thereby promptly suggest a preoperative diagnosis of intradural lumbar disc herniation. Surgeons need to avoid omitting intraoperative lesions by palpating the dura mater during surgery for suspected tumor cases.