Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China.
Clin Interv Aging. 2019 Dec 23;14:2295-2299. doi: 10.2147/CIA.S228717. eCollection 2019.
Lumbar disc herniation into the dural space is a very rare phenomenon of degenerative lumbar lesions in the elderly population, and its potential pathogenesis and natural course remain unclear.
We describe a rare case of intradural lumbar disc herniation. A 68-year-old man presented with progressive lower back pain and radiating pain and numbness in both legs for 3 years. Magnetic resonance imaging revealed a large herniated disc at L4-L5. Posterior discectomy and fusion of the L4-L5 was performed after conservative treatment failed. Intraoperatively, only minimal disc fragments in the epidural space were found after meticulous probing following laminectomy of the L4-L5 vertebrae. The dorsal dura mater was saturated, tense, and bulged at the L4-L5 levels; additionally, an intradural mass was palpable and confirmed by intraoperative ultrasonography. Subsequently, dorsal middle durotomy was performed. Upon opening the dural sac, a large cauliflower-like mass similar to nucleus pulposus tissue was found near the arachnoid membrane. The mass was dissociative and could be completely resected. The dorsal dural incisions were closed after careful exploration, followed by fixation and fusion of the L4-L5 levels. Pathological examination revealed disc tissue with central balloon-type cystic degenerative changes. The patient's lower back pain and radiating pain and numbness of both legs improved remarkably postoperatively, and he became asymptomatic at 3 months postoperatively.
Intradural lumbar disc herniation should be highly suspected when intraoperative findings are incompatible with findings from the preoperative imaging examination, and it could be further confirmed via intraoperative ultrasonography and pathological examination of the resected tissue from the dural space. Prompt surgery is recommended, and surgical results are usually favorable. We also reviewed the literature and discussed the potential pathogenesis, natural course, diagnosis, and treatment of intradural lumbar disc herniation.
腰椎间盘突入硬脊膜腔是老年人退行性腰椎病变中非常罕见的现象，其潜在的发病机制和自然病程仍不清楚。
我们描述了一例罕见的硬脊膜内腰椎间盘突出症病例。一名 68 岁男性，因进行性腰痛和双腿放射痛伴麻木 3 年来就诊。磁共振成像显示 L4-L5 椎间盘巨大突出。在保守治疗失败后，行 L4-L5 后路椎间盘切除和融合术。在进行 L4-L5 椎板切除后，进行精细探查，仅在硬膜外间隙发现少量椎间盘碎片。背侧硬脊膜饱满、紧张、膨隆于 L4-L5 水平；此外，术中超声检查可触及硬脊膜内肿块。随后，行背侧正中硬脊膜切开术。打开硬脊膜囊后，在蛛网膜附近发现一个类似髓核组织的大菜花状肿块。肿块呈分离状，可完全切除。仔细探查后，关闭硬脊膜切口，然后固定和融合 L4-L5 水平。病理检查显示椎间盘组织有中心气球样囊性退行性变。术后患者腰痛和双腿放射痛及麻木明显改善，术后 3 个月无症状。
当术中发现与术前影像学检查结果不一致时，应高度怀疑硬脊膜内腰椎间盘突出症，可通过术中超声和硬脊膜内切除组织的病理检查进一步明确。建议及时手术，手术效果通常良好。我们还回顾了文献，讨论了硬脊膜内腰椎间盘突出症的潜在发病机制、自然病程、诊断和治疗。
