Ihejirika Rivka Chinyere, Tong Yixuan, Patel Karan, Protopsaltis Themistocles
Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York.
J Neurosurg Case Lessons. 2021 Nov 1;2(18):CASE21336. doi: 10.3171/CASE21336.
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.
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.
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.
硬膜内腰椎间盘突出症（ILDH）占椎间盘突出症的比例不到0.4%，是一种罕见的病症，主要被描述为腰椎手术后的并发症。据推测，椎间盘突出可能从初次手术后未被识别的硬脊膜缺损处向硬膜内蔓延，或者是由于硬脊膜与后纵韧带之间的粘连所致。本报告探讨了ILDH的病因、临床表现、诊断评估和治疗方法，并伴有病例报告和显微手术视频。
一名67岁患者，1年前接受了L2-5椎板切除术和L2-3减压术，无已知并发症，现出现腰痛以及右下肢、臀部和腹股沟放射性疼痛1个月。体格检查未发现麻木或无力。磁共振成像显示巨大的硬膜内腰椎间盘突出。进行了经椎间孔椎间融合术，随后进行硬脊膜切开、ILDH切除和硬脊膜闭合。术中发现并修复了腹侧硬脊膜缺损。
ILDH的治疗方法是椎板切除术加背侧硬脊膜切开术。由于ILDH在文献中很少被描述，了解其临床表现对于及时识别和处理至关重要。
