Intradural lumbar disc herniations at the L1-L2 level: A case study and literature review

Giancarlo Ponzo; Massimo Furnari; Giuseppe Emmanuele Umana; Massimiliano Giuffrida; Giovanni Federico Nicoletti; Gianluca Scalia

doi:10.25259/SNI_108_2020

Intradural lumbar disc herniations at the L1-L2 level: A case study and literature review

Surg Neurol Int. 2020 Apr 11:11:67. doi: 10.25259/SNI_108_2020. eCollection 2020.

Authors

Giancarlo Ponzo¹, Massimo Furnari¹, Giuseppe Emmanuele Umana², Massimiliano Giuffrida¹, Giovanni Federico Nicoletti¹, Gianluca Scalia³

Affiliations

¹ Department of Neurosurgery, ARNAS Garibaldi, Via Palermo, Catania.
² Department of Neurosurgery, Cannizzaro Hospital, Via Messina, Catania.
³ Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Division of Neurosurgery, University of Messina, Via Consolare Valeria, Messina Sicily, Italy.

Abstract

Background: Intradural disc herniations (IDHs) are rare occurrences (0.26-0.30%), and most frequently involve the lumbar spine at the L4-L5 level. Here, we present a patient with an L1-L2 IDH and reviewed the current literature.

Case description: A 65-year-old female presented with the acute onset of bilateral paraparesis accompanied by urinary dysfunction. The lumbar MRI showed a mass at the L1-L2 level with caudal migration, accompanied by a positive "hawk-beak" sign. At surgery, consisting of a L1-L2 laminectomy, a large IDH was encountered responsible for marked cauda equina/root compression. Postoperatively, the patient immediately fully recovered. The literature we identified cited just seven similar studies of L1-L2 IDH.

Conclusion: In a 65-year-old female, an IDH was anticipated at the L1-L2 level due to the combined MR findings of a large L1-L2 mass with caudal migration and the positive "hawk-beak" sign.

Keywords: Disc herniation; Hawk beak; Intradural; Lumbar; Posterior longitudinal ligament.

Publication types

Case Reports