Intradural Lumbar Disc Herniation with Intradural Gas: Report of Three Cases

Seung Eun Chung, Sang Ho Lee, Tae Hong Kim, Byung June Jo
2005 Journal of the Korean Radiological Society  
Intradural disc herniation is a very rare condition with an incidence that ranges from 0.26% to 0.30% of all herniated discs (1). Myelography, computed tomography (CT) and magnetic resonance imaging (MRI) are generally used to diagnose intradural lumbar disc herniation (IDLDH), but there can be some differences according to each case. Several studies have reported of a potential association between intradural disc herniation and gas within the spinal canal. However, to our knowledge, there are
more » ... o reports of IDLDH together with intradural vacuum (IDV). This report presents three cases of IDLDH that were diagnosed by a radiological examination with a review of the relevant literature. Case Reports Case 1 A 54-year-old man with a 15-year history of chronic back pain was admitted with complains of severe back pain and right radiculopathy of a three-day duration. A physical examination showed no reflex in the right knee. The CT scan revealed a right paracentral soft tissue lesion that contained intradural gas at the L3 4 level (Fig. 1A) . The sagittal T2-weighted image showed an intradural iso-intensity mass at the L3 4 level with a peripheral lower-intensity rim signal (Fig. 1B) . The axial T2-weighted image demonstrated that the Rt. intradural herniated disc material contained gas that had passed through a Rt. posterior annular tear (Fig. 1C) . The patient was preoperatively diagnosed with Rt. intradural herniated disc material that contained gas at the L3 4 level, and he underwent an open lumbar microdiscectomy. On the surgical field, the right L4 nerve root was severely compressed by the transligamentously-extruding disc, and there were dense adhesions between the PLL and the dura. A longitudinal incision was made in the dura mater and the intradural disc fragment was removed. He showed a marked improvement in his symptoms on the follow-up examinations. Case 2 A 62-year-old female with a 10-year history of right buttock and leg pain was admitted to the hospital due to 445
doi:10.3348/jkrs.2005.53.6.445 fatcat:3jn63gxbmncjbo6ke2qmn56zey