Yu Yangyi, Yang Zhong, Xiang Yucheng, Wan Yong, Jin Hongtao, Fan Pengjie, Li Guangheng, Gao Guoyong
Department of Bone and Joint Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen Key Laboratory of Reconstruction of Sports System Shenzhen 518020, Guangdong, China.
Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen Key Laboratory of Reconstruction of Sports System Shenzhen 518020, Guangdong, China.
Am J Transl Res. 2021 Sep 15;13(9):10891-10895. eCollection 2021.
Lumbar disc herniation (LDH) is a common disease, with a conventional treatment method, as well as well-established surgical procedure, when necessary. However, some rare cases of LDH, such as intradural disc herniation (IDH), accounting for a very small proportion (approximately 0.3%) of all LDH cases, could lead to intra-operation or post-operation complications, which requires a more circumspect pre-operational radiology analysis and overall management. Herein, we reported a case with L3-L4 IDH identified by pathological examination. Recent studies on PubMed were reviewed to summarize the unique characteristics of IDH, as well as diagnosis and treatments. Case introduction: A 69-year-old male was admitted to our department due to complaints of chronic low back pain for the past one month, along with radiating pain along the left lower hip and posterolateral left lower extremity. Disk herniation and space-occupying mass inside the canal at the L3-L4 level were confirmed by both lumbar CT and MRI. In surgery, after resection of the disc at L3-L4, further exploration revealed unsatisfactory volume of disk tissue and local eminence posterior to ventral dura, which emphasized the need for preoperatively identifying the mass inside the spinal canal. The tumor-like mass was found inside the dura. Finally, transforaminal lumbar interbody fusion (TLIF) was performed followed by resection of the mass. However, the histology examination showed a disc-like fibrocartilage tissue. The symptoms were immensely improved after the operation.
IDH has a low incidence and is sporadically reported. Misdiagnosis is very common preoperatively as well as intraoperatively. IDH usually develops more rapidly compared with intradural tumors. Adhesion between dura mater and posterior longitudinal ligament may play a critical role in the disease onset.
腰椎间盘突出症（LDH）是一种常见疾病，有常规治疗方法，必要时也有成熟的手术程序。然而，一些罕见的腰椎间盘突出症病例，如硬膜内椎间盘突出症（IDH），在所有腰椎间盘突出症病例中所占比例非常小（约0.3%），可能导致术中或术后并发症，这需要更谨慎的术前放射学分析和整体管理。在此，我们报告一例经病理检查确诊为L3-L4节段硬膜内椎间盘突出症的病例。回顾了PubMed上的近期研究，以总结硬膜内椎间盘突出症的独特特征以及诊断和治疗方法。病例介绍：一名69岁男性因过去一个月慢性腰痛伴左髋部及左下肢后外侧放射痛入院。腰椎CT和MRI均证实L3-L4节段椎间盘突出及椎管内占位性肿块。手术中，切除L3-L4椎间盘后，进一步探查发现椎间盘组织量不理想，腹侧硬脊膜后方局部隆起，这凸显了术前识别椎管内肿块的必要性。在硬脊膜内发现了肿瘤样肿块。最后，进行了经椎间孔腰椎椎间融合术（TLIF），随后切除肿块。然而，组织学检查显示为盘状纤维软骨组织。术后症状明显改善。
硬膜内椎间盘突出症发病率低，零星报道。术前及术中误诊非常常见。与硬膜内肿瘤相比，硬膜内椎间盘突出症通常发展更快。硬脊膜与后纵韧带之间的粘连可能在疾病发病中起关键作用。
