El-Sherif Ahmed, Mostafa Mostafa A
Neurosurgery, Al-Azhar University, Giza, EGY.
Cureus. 2024 Dec 21;16(12):e76128. doi: 10.7759/cureus.76128. eCollection 2024 Dec.
Intradural disc herniation (IDDH) is a rare condition, accounting for less than 0.5% of herniated disc cases, primarily affecting the lumbar region and often presenting with severe nerve compression or cauda equina syndrome. This paper presents the case of a 60-year-old female with a history of hypertension, dyslipidemia, stroke, and hypothyroidism, who arrived with severe lower back pain, lower limb weakness, and urinary retention. MRI indicated a posterior dural-based mass with significant cauda equina compression and lumbar instability at L3-L4. During surgery, an IDDH was suspected due to adhesions, initially resembling a meningioma, and was confirmed histopathologically. Following excision and spinal fixation, the patient experienced substantial improvement in motor function and pain levels. This case underscores the need to consider IDDH in differential diagnoses for patients with severe neurological deficits, especially when imaging suggests neoplasms. Surgical intervention led to favorable outcomes, highlighting the importance of IDDH awareness and the need for further research into its pathogenesis and treatment guidelines.
硬膜内椎间盘突出症（IDDH）是一种罕见疾病，占椎间盘突出病例的比例不到0.5%，主要影响腰椎区域，常表现为严重的神经受压或马尾综合征。本文介绍了一名60岁女性病例，该患者有高血压、血脂异常、中风和甲状腺功能减退病史，因严重的下背部疼痛、下肢无力和尿潴留前来就诊。磁共振成像（MRI）显示硬膜后肿块，伴有明显的马尾神经受压以及L3-L4节段腰椎不稳。手术过程中，由于粘连，最初怀疑为硬膜内椎间盘突出症，类似脑膜瘤，经组织病理学确诊。切除并进行脊柱固定后，患者的运动功能和疼痛程度有了显著改善。该病例强调，对于有严重神经功能缺损的患者，尤其是影像学提示肿瘤时，在鉴别诊断中需要考虑硬膜内椎间盘突出症。手术干预取得了良好效果，凸显了认识硬膜内椎间盘突出症的重要性以及对其发病机制和治疗指南进行进一步研究的必要性。
