Intradural sequestration of lumbar disc herniation with cranial migration: a case report
https://doi.org/10.47093/2218-7332.2024.15.4.51-58
Abstract
Intradural herniation of the intervertebral disc (IHID) is extremely rare. There are only a few reports of cranial migration of an intradural fragment of a sequestered disc herniation.
Clinical case. A 51-year-old patient who had previously undergone two operations at L5–S1 and L4–L5 levels was admitted to the hospital with complaints of low back pain with radiation to both legs, numbness in the perineum and inner surface of the thighs, urinary retention, constipation. Magnetic resonance imaging revealed a 30 mm mass located at the level of the L3 vertebral body, within the dural sac and filling its entire transverse diameter. The cauda equina nerve roots were compressed. Surgery was performed: the herniated sequestrum (30×10×10 mm) was separated from the nerve roots fixed to it and removed. After surgery, sensation in the buttocks and inner thighs returned, and urinary urge appeared. Rehabilitation is ongoing.
Discussion. In most cases, IHID is diagnosed intraoperatively. In the presented case, the genesis of the formation remained unclear before surgery, so a laminectomy approach was chosen, which allowed for extensive revision of the intradural space, thorough radiculolysis, and identification of the cranial migration of the sequestrated disc herniation. The only effective treatment for IHID is surgery.
About the Authors
Grigoriy Yu. Evzikov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Grigoriy Yu. Evzikov – Doctor of Sci. (Medicine), Professor, Department of Nervous Diseases and Neurosurgery,
8/2, Trubetskaya str., Moscow, 119048.
Mikhail G. Bashlachev
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Mikhail G. Bashlachev – Cand. of Sci. (Medicine), neurosurgeon, Neurosurgical Department with an Operating Unit, Kozhevnikov Clinic of Nervous Diseases, University Clinical Hospital No. 3,
8/2, Trubetskaya str., Moscow, 119048.
Maksim I. Gaydash
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Maksim I. Gaydash, Maksim I. Gaydash – neurologist, postgraduate student, Department of Nervous Diseases and Neurosurgery,
8/2, Trubetskaya str., Moscow, 119048.
References
1. Loya V.K., Krishna Narayan T.V., Singh Dhillon C., Shashikant Pophale C. Intradural lumbar disc herniation with cauda equina syndrome: Case report and recent advances. Brain Spine. 2023 Dec 14; 4: 102724. https://doi.org/10.1016/j.bas.2023.102724. PMID: 38510606
2. Байков Е.С., Крутько А.В. Грыжи межпозвонковых дисков с интрадуральной миграцией их фрагментов. Хирургия позвоночника. 2016; 13(4): 73–77. https://doi.org/10.14531/ss2016.4.73-77. EDN: XBKHFD / Baikov E.S., Krutko A.V. Intervertebral disc herniation with intradural migra tion of fragments. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2016; 13(4): 73–77 (In Russian). https://doi.org/10.14531/ss2016.4.73-77. EDN: XBKHFD
3. Jin Y.Z., Zhao B., Zhao X.F., et al. Lumbar intradural disc herniation caused by injury: a case report and literature review. Orthop Surg. 2023 Jun; 15(6): 1694–1701. https://doi.org/10.1111/os.13723. PMID: 37073103
4. Wen H., Xiao L., Chen Y., et al. Intradural disc herniation at the L2/3 level: a case report and literature review. Annals of palliative medicine. 2022 Sep; 11(9): 3005–3013. https://doi.org/10.21037/apm-22-1017. PMID: 36217628
5. Floeth F., Herdmann J. Chronic dura erosion and intradural lumbar disc herniation: CT and MR imaging and intraoperative photographs of a transdural sequestrectomy. European spine J. 2012 Jun; 21 Suppl 4(Suppl 4): S453–457. https://doi.org/10.1007/s00586-011-2073-2. PMID: 22109565
6. Rathod T., Panchal S., Marathe N., et al. Intradural disc herniation in the lumbar spine: a case report. JNMA J. Nepal Med Assoc. 2020 May 30; 58(225): 345–348. https://doi.org/10.31729/jnma.4798. PMID: 32538932
7. Pedaballe A.R., Mallepally A.R., Tandon V., et al. An unusual case of transdural herniation of a lumbar intervertebral disc: diagnostic and surgical challenges. World Neurosurg. 2019 Aug; 128: 385–389. https://doi.org/10.1016/j.wneu.2019.05.103. PMID: 31121367
8. Luo D., Ji C., Xu H., et al. Intradural disc herniation at L4/5 level causing Cauda equina syndrome: A case report. Medicine (Baltimore). 2020 Feb; 99(7): e19025. https://doi.org/10.1097/MD.0000000000019025. PMID: 32049799
9. Theodorou D.J., Theodorou S.J., Kakitsubata Y., et al. P osterior and anterior epidural and intradural migration of the sequestered intervertebral disc: Three cases and review of the literature. J. Spinal Cord Med. 2022 Mar; 45(2): 305–310. https://doi.org/10.1080/10790268.2020.1730110. PMID: 32130089
10. Tempel Z., Zhu X., McDowell M.M., et al. Severe intradural lumbar disc herniation with cranially oriented free fragment migration. World Neurosurg. 2016 Aug; 92: 582.e1–582.e4. Epub 2016 Jun 16. https://doi.org/10.1016/j.wneu.2016.06.024. PMID: 27318310
11. Singh P.K., Shrivastava S., Dulani R., et al. Dorsal herniation of cauda equina due to sequestrated intradural disc. Asian Spine J. 2012 Jun; 6(2): 145–147. https://doi.org/10.4184/asj.2012.6.2.145. PMID: 22708020
12. Reina E.G., Calonge E.R., Heriot R.P. Transdural lumbar disc herniation. Spine (Phila Pa 1976). 1994 Mar 1; 19(5): 617–619. https:// doi.org/10.1097/00007632-199403000-00020. PMID: 8184359
13. Oztürk A., Avci E., Yazgan P., et al. Intradural herniation of intervertebral disc at the level of Lumbar 1-Lumbar 2. Turk Neurosurg. 2007 Apr; 17(2): 134–137. PMID: 17935031
14. Sarliève P., Delabrousse E., Clair C., et al. Intradural disc herniation with cranial migration of an excluded fragment. Clin Imaging. 2004 May-Jun; 28(3): 170–172. https://doi.org/10.1016/S0899-7071(03)00147-5. PMID: 15158220
15. Choi J.Y., Lee W.S., Sung K.H. Intradural lumbar disc herniation – is it predictable preoperatively? A report of two cases. Spine J. 2007 Jan-Feb; 7(1): 111–117. https://doi.org/10.1016/j.spinee.2006.02.025. PMID: 17197344
16. Kim H.S., Eun J.P., Park J.S. Intradural migration of a sequestrated lumbar disc fragment masquerading as a spinal intradural tumor. J. Korean Neurosurg Soc. 2012 Aug; 52(2): 156–158. https://doi.org/10.3340/jkns.2012.52.2.156. PMID: 23091677
17. Daffner S.D., Sedney C.L., Rosen C.L. Migratory intradural disk herniation and a strategy for intraoperative localization. Global Spine J. 2015 Feb; 5(1): 55–58. https://doi.org/10.1055/s-0034-1381728. PMID: 25648315
18. Park Y.S., Hyun S.J., Kim K.J., Jahng T.A. Multiple intradural disc herniations masquerading as intradural extramedullary tumors: a case report and review of the literature. Korean J. Spine. 2016 Mar; 13(1): 30–32. https://doi.org/10.14245/kjs.2016.13.1.30. PMID: 27123028
19. Cheng C.H., Che-Chao Chang M.P., Lin H.L., et al. Intradural lumbar disc herniation: A case report and literature review. Heliyon. 2022 Dec 14; 8(12): e12257. https://doi.org/10.1016/j.heliyon.2022.e12257. PMID: 36578377
20. Matsumoto T., Toyoda H., Terai H., et al. Utility of discography as a preoperative diagnostic tool for intradural lumbar disc herniation. Asian Spine J. 2016 Aug; 10(4): 771–775. https://doi.org/10.4184/asj.2016.10.4.771. PMID: 27559461
21. Wasserstrom R., Mamourian A.C., Black J.F., Lehman R.A. Intradural lumbar disk fragment with ring enhancement on MR. AJNR Am J. Neuroradiol. 1993 Mar-Apr; 14(2): 401–404. PMID: 8456719
22. Ihejirika R.C., Tong Y., Patel K., Protopsaltis T. Intradural lumbar disc herniation: illustrative case. J. Neurosurg Case Lessons. 2021 Nov 1; 2(18): CASE21336. https://doi.org/10.3171/CASE21336. PMID: 36061623
23. Arrigo R.T., Kalanithi P., Boakye M. Is cauda equina syndrome being treated within the recommended time frame? Neurosurgery. 2011 Jun; 68(6): 1520–1526; discussion 1526. https://doi.org/10.1227/NEU.0b013e31820cd426. Erratum in: Neurosurgery. 2012 May; 70(5): 1324–1325 . PMID: 21311382
24. Kobayashi K., Imagama S., Matsubara Y., et al. Intradural disc herniation: radiographic fi fi ndings and surgical results with a literature review. Clin Neurol Neurosurg. 2014 Oct; 125: 47–51. https://doi.org/10.1016/j.clineuro.2014.06.033. PMID: 25086430
25. Huliyappa H.A., Singh R.K., Singh S.K., et al. Transdural herniated lumbar disc disease with muscle patch for closure of durotomy – A Brief review of literature. Neurol Neurochir Pol. 2017 Mar-Apr; 51(2): 149–155. https://doi.org/10.1016/j.pjnns.2016.12.002. PMID: 28024891
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