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Intradural disc herniation: how I do it

  • How I Do it - Spine
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Abstract

Background

Intradural disc herniation is a rare phenomenon in spine surgery. Diagnosis is difficult despite current neuroradiologic imaging techniques.

Method

We present a case of a 59-year-old man with lumbar and radicular pain and a recurrent lumbar herniation. A laminectomy was performed after no clear disc herniation in the epidural space was found and an intradural mass was palpable. A durotomy showed an intradural disc fragment that was removed, followed by an arthrodesis.

Conclusion

Only intraoperative findings lead to a definitive diagnosis for intradural herniation. A durotomy needs to be performed. In this case, an arthrodesis was necessary to avoid complications of segmental instability.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, 50009, Zaragoza, Spain

    Víctor Rodrigo, Marta Claramonte, Mónica Martín & Juan B. Calatayud

Authors
  1. Víctor Rodrigo
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  2. Marta Claramonte
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  3. Mónica Martín
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  4. Juan B. Calatayud
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Corresponding author

Correspondence to Víctor Rodrigo.

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Informed patient consent

The authors received consent from the patient to participate in the submission.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Key points

1. IDH is a very rare phenomenon.

2. The PLL is a very resistant structure and the physiopathology of this entity remains unclear.

3. Examination of the MRI is mandatory. Suspect an intradural disc herniation if there is loss of continuity of the PLL or a ring enhancement of the herniated portion is shown after contrast injection.

4. Intraoperative ultrasound is useful to confirm the intradural mass.

5. Surgical anterior and posterior dural opening may be utilized.

6. Use of surgical microscope for good visualization of the herniation after the dural incision, minimizing injuries to the nervous rootlets.

7. Careful and gentle dissection of the dense adhesions between the disc space and the dural sac.

8. Water-tight closure in the anterior and posterior aspect of the dural sac.

9. Absolute rest during 24–48 h in the postoperative period is recommended.

10. Patients should be informed post-operatively about the difficulty of the procedure.

Electronic supplementary material

This Video shows the transdural discectomy. (MP4 288,560 kb)

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Rodrigo, V., Claramonte, M., Martín, M. et al. Intradural disc herniation: how I do it. Acta Neurochir 160, 945–947 (2018). https://doi.org/10.1007/s00701-018-3510-3

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  • DOI: https://doi.org/10.1007/s00701-018-3510-3

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