Transdural lumbar disc herniation: experiences often ten cases with review of literature

Ayman Elsayed Galhom, Mohamed Elhadi


Background: Intradural or intraradicular lumbar disc herniations are uncommon presentations of a relatively frequent pathology, representing less than 1% of all lumbar disc hernias.
Methods: The purpose of this study was to analyze the mechanism, clinical, radiological, and the surgical treatment requires a transdural discectomy. Ten cases of intradural and intraradicular disc were analyzed retrospectively. The cases comprised 0.5% of the 620 cases of lumbar disc that underwent surgery from 2000 to 2015. The data described the causes of this pathology, and analyzed it from clinical, diagnostic, and therapeutic perspectives. The difficulties in the preoperative diagnosis issues and the surgical techniques will be interpreted.
Results: The commonest involved site is at level L4–L5. In intradural herniation, most patients reported a chronic history of back pain, complicated later by neurologic signs. In intraradicular extension, the patients were usually complaining of severe sciatica. In the present series, diagnosis was obtained by means of magnetic resonance image. All patients underwent surgery were reporting excellent results in six cases and good results in the other four. Surgery was performed either with laminectomy for intradural extension and fenestration discectomy for intraradicular extension. Dorsal dural was repaired only, with no leakage of the cerebrospinal fluid.
Conclusions: In intradural and intraradicular disc herniations; the diagnosis is mainly intraoperative, but MRI could help, the surgical technique has some special aspects, and the prognosis is good.

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