硬脊膜内椎间盘突出症的多专业视角：诊断与治疗——病例报告
Multispecialty perspective on intradural disc herniation: diagnosis and management - A case report.
作者信息
Francio Vinicius Tieppo, Wie Christopher S, Murphy Micheal T, Neal Matthew T, Lyons Mark K, Gibbs Wende N, Strand Natalie H
机构信息
Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.
Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA.
出版信息
Anesth Pain Med (Seoul). 2022 Apr;17(2):221-227. doi: 10.17085/apm.21100. Epub 2022 Apr 1.
BACKGROUND
Intradural disc herniation (IDH) is a very rare and challenging diagnosis, with an estimated incidence of less than 1.5%. The pathogenesis of IDH remains uncertain. Definitive management remains surgical; however, some cases may initially be managed non-surgically.
CASE
A middle-aged male with presented with acute right-sided lumbar radiculopathy following heavy lifting. History was significant for prior lumbar disc herniation managed non-surgically. Lumbar MRI demonstrated a large disc herniation. The patient was initially treated non-surgically with epidural steroid injections. At 4-months, he re-injured and follow-up images demonstrated the herniated disc penetrating the dura and the diagnosis of intradural disc herniation.
CONCLUSIONS
The present case is rare because the IDH occurred at the L3-4 level and resulted in unilateral radiculopathy without cauda-equina symptoms and occurred in the absence of prior surgery. This patient was initially treated non-surgically with satisfactory relief, however, reinjury led to progression of IDH with new neurological deficits necessitating surgery.
背景
硬膜内椎间盘突出症（IDH）是一种非常罕见且具有挑战性的诊断，估计发病率低于1.5%。IDH的发病机制仍不确定。明确的治疗方法仍是手术；然而，一些病例最初可能采用非手术治疗。
病例
一名中年男性在重物搬运后出现急性右侧腰神经根病。既往有腰椎间盘突出症非手术治疗史。腰椎MRI显示巨大椎间盘突出。患者最初接受硬膜外类固醇注射非手术治疗。4个月时，他再次受伤，随访影像显示突出的椎间盘穿透硬脊膜，诊断为硬膜内椎间盘突出症。
结论
本病例罕见，因为IDH发生在L3-4水平，导致单侧神经根病而无马尾神经症状，且在无既往手术史的情况下发生。该患者最初接受非手术治疗，症状缓解满意，然而，再次受伤导致IDH进展并出现新的神经功能缺损，需要手术治疗。
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