The importance of opening and probing the dura matter during surgery for intradural lumbar disc herniation with cauda equina syndrome: a case report

Abstract

Background Intradural lumbar disc herniation (ILDH), first reported in 1942, was a rare pathological type. Enhanced magnetic resonance imaging (MRI) is the “gold standard” for ILDH diagnosis but is rarely used for routine diagnosis of lumbar disc disease. Definite diagnosis often occurs intraoperatively. Case presentation A patient (52‐year‐old, man) was enrolled in the Affiliated Hospital of Zunyi Medical University admitted because of “low back pain with numbness and radiating pain in the left lower extremity for 5 years, with aggravation for 1 month and urinary incontinence for 6 days”. The patient was diagnosed with intradural lumbar disc herniation‐induced cauda equina syndrome at the L4‐5 vertebrae. Other diagnoses, such as epidural hematoma, arachnoiditis, abscesses, and tumors, were deemed unlikely. During the patient underwent emergency lumbar decompression, the potential presence of intradural disc herniation was found when we performed the open discectomy. So, if no significant disc is found outside the dura matter, consideration should be given to open and prob the dura matter. But previous studies haven't made it clear what to do about it. In this way, one day after surgery, the pain in the lower extremities was significantly relieved. Follow‐up 2 years after the operation showed that the clinical effect of the treatment scheme was significant. Conclusion The report of this case was to provide reference images and a clinical basis for the diagnosis, treatment, and prognosis of ILDH.

Keywords

• Lumbar disc herniation
• Intradural disc herniation
• Case report
• Degenerative disc disease
• Dural adhesion
• Open discectomy