Segi Naoki, Ando Kei, Nakashima Hiroaki, Machino Masaaki, Imagama Shiro
Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya, JPN.
Cureus. 2022 Feb 20;14(2):e22418. doi: 10.7759/cureus.22418. eCollection 2022 Feb.
Intradural disc herniation (IDH) is usually diagnosed during surgery when a herniated mass is found to have penetrated the ventral dura. We experienced a case of IDH that entered the dura from the lateral side with no penetrating hole. A 61-year-old man presented to our institution with left leg pain of two months' duration. Plain x-ray imaging showed degeneration of the lumbar spine, and a magnetic resonance imaging (MRI) scan revealed a suspected tumor at the L3-L4 level. Two weeks later, the patient suffered from acute cauda equina syndrome. A gadolinium-enhanced MRI showed an enlarged lesion with no enhancement visible, and emergency surgery was performed. The lesion originated from the left side of the dura. Despite the white debris suggesting a herniated disc, no penetrating hole was found in the dura. Pathologically, the lesion was found to be an intervertebral disc and was diagnosed as an intradural lumbar disc herniation. The patient's neurological symptoms improved, but he did not recover his left ankle dorsiflexion. In a degenerated lumbar spine, IDH may not always originate from the ventral dura and may not be accompanied by a penetrating hole.
硬膜内椎间盘突出症（IDH）通常在手术中发现突出的肿块穿透腹侧硬脑膜时被诊断出来。我们遇到了一例IDH，它从侧面进入硬脑膜，没有穿透孔。一名61岁男性因左腿疼痛两个月前来我院就诊。X线平片显示腰椎退变，磁共振成像（MRI）扫描显示L3-L4水平疑似肿瘤。两周后，患者出现急性马尾综合征。钆增强MRI显示病变增大但无强化，遂进行急诊手术。病变起源于硬脑膜左侧。尽管白色碎屑提示椎间盘突出，但在硬脑膜上未发现穿透孔。病理检查发现病变为椎间盘，诊断为硬膜内腰椎间盘突出症。患者的神经症状有所改善，但左脚背屈未恢复。在退变的腰椎中，IDH可能并不总是起源于腹侧硬脑膜，也可能不伴有穿透孔。
