Background: Accounting for less than 0.4% of disc herniations, intradural lumbar disc herniations (ILDHs) are a rare occurrence primarily described as a complication after lumbar spine surgery. It is speculated that the herniation may propagate intradurally from either an unrecognized dural defect after initial surgery or as a result of adhesions between the dura and posterior longitudinal ligament. This report explores the etiology, presentation, diagnostic evaluation, and treatment of ILDH along with a case report and microsurgery video.
Observations: A 67-year-old patient who 1 year earlier had undergone an L2-5 laminectomy and L2-3 decompression with no known complications presented with low back pain and radiating right leg, buttock, and groin pain for 1 month. Physical examination indicated no numbness or weakness. Magnetic resonance imaging demonstrated a large ILDH. A transforaminal interbody fusion was performed followed by a durotomy, ILDH removal, and dural closure. A ventral dural defect was found and repaired during the procedure.
Lessons: The treatment for ILDH is laminectomy with dorsal durotomy. Because ILDH has rarely been described in literature, understanding its presentation is crucial for prompt identification and management.
Keywords: PLL = posterior longitudinal ligament; CSF = cerebrospinal fluid; ILDH; ILDH = intradural lumbar disc herniation; LDH = lumbar disc herniation; MRI = magnetic resonance imaging; cauda equina syndrome; intradural lumbar disc herniation; spine surgery.
© 2021 The authors.