Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis

Abstract

Jia Chen,1,2 Hai-Jian Ni,1,2 Fei Xue,3 Yun-Shan Fan,1,2 Xi-Fan Li,4 Xian-Zhen Chen,3 Shi-Sheng He1,2 1Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 2Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 3Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 4Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of ChinaCorrespondence: Shi-Sheng HeSpinal Pain Research Institute, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail [email protected] ChenDepartment of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail [email protected]: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms.Case Description: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient’s pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up.Conclusion: Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.Keywords: lower back pain, radiating pain, upper lumbar, intradural disc herniation, case report

Keywords

• lower back pain
• radiating pain
• upper lumbar
• intradural disc herniation
• case report