Intradural lumbar disc herniation: case report
Year: 2025
Type: article
Study design: Case Report
Abstract: Intradural disc herniation is a rare complication that, despite the precision of modern diagnostic tools, is usually confirmed intraoperatively. Therefore, we aimed to present a case of intradural disc herniation, reviewing the incidence, pathogenesis, clinical presentation, diagnostic options, and management. A 67-year-old man presented with a history of hypertension, rheumatoid arthritis, and previous surgery for a herniated disc at the L4–L5 level. He was suffering from severe low back pain radiating towards the legs for four weeks that was followed by progressive weakness of the lower extremities to the point of inability to walk unassisted. The neurological examination demonstrated weakness of the muscles of both thighs and distal legs, absent knee-jerk and Achilles reflexes bilaterally, hypoesthesia of L4, L5, and S1 dermatomes bilaterally, and inability for plantar and dorsiflexion of the feet, while the bowel and bladder control were preserved. Magnetic resonance imaging (MRI) showed signs suggestive of disruption of the posterior longitudinal ligament at the L3–L4 level, the presence of intradural air, and a ratio between the maximum diameter of the herniated disc and the maximum diameter of the dural sac of 0.75. These findings made us suspect an intradural herniated disc at the L3–L4 level that was confirmed intraoperatively. MRI findings that detect disruption of the posterior longitudinal ligament, presence of air in the intradural space, and a high ratio between the maximum diameters of the herniated disc and the dural sac are suggestive of the diagnosis, especially in the presence of two or more imaging findings.
Source: Folia Medica
Institution: Medical University Plovdiv
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415650717