Radicular interdural lumbar disc herniation

Eur Spine J. 2010 Jul;19 Suppl 2(Suppl 2):S149-52. doi: 10.1007/s00586-009-1200-9. Epub 2009 Nov 4.

Abstract

Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5-S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Dura Mater / pathology*
  • Dura Mater / physiopathology
  • Dura Mater / surgery
  • Humans
  • Intervertebral Disc / pathology*
  • Intervertebral Disc / physiopathology
  • Intervertebral Disc / surgery
  • Intervertebral Disc Displacement / pathology*
  • Intervertebral Disc Displacement / physiopathology
  • Intervertebral Disc Displacement / surgery
  • Low Back Pain / etiology
  • Lumbar Vertebrae / pathology*
  • Lumbar Vertebrae / physiopathology
  • Lumbar Vertebrae / surgery
  • Male
  • Radiculopathy / pathology*
  • Radiculopathy / physiopathology
  • Radiculopathy / surgery
  • Radiography
  • Spinal Canal / diagnostic imaging
  • Spinal Canal / pathology
  • Spinal Canal / surgery
  • Treatment Outcome