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KMID : 0378019720150020125
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New Medical Journal
1972 Volume.15 No. 2 p.125 ~ p.128
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Intradurally Herniated Lumbar Nucleus Pulposus
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朴靑수/Park, Cheong Soo
韓大熙/朱正和/沈輔星/Han, Dae Hee/Chu, Jeong Wha/Sim, Bo Sung
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Abstract
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Rarely the central part of the posterior longitudinal ligament is perforated by herniated lumbar disc. It is even more rare that the herniated lumbar disc is situated intrathecally through the perforation of the ventral surface of the spinal dura. Since the first report of Dandy in 1942, only eleven such cases have been reported.
A 31 years old Korean male was admitted to Seoul National University Hospital with the chief complaints of lumbago, radiating leg pain on both sides, urinary retention and saddle anesthesia. Physical and neurological examination showed marked wasting of left calf muscle, decreased superficial sensation below L5 spinal dermatome on both sides, decreased dorsiflexion of left big toe and foot, bilateral abscence of ankle jerk and retention type of sphincter dysfunction. Myelogram showed a complete block at the level of the fourth lumbar vertebral body, suggesting an intradural mass lesion.
Total laminectony of the L4 and L5 was performed and an intradural mass was palpable at L4 vertebral level. Opening the dorsal dura a yellowish white solid mass was found in the space between the ventral dura and arachnoid membrane. Tearing the ventral arachnoid membrane the mass extruded through an opening in the ventral dura appeared to be a nucleus pulposus herniated through the L4_5 intervertebral space. An intrathecal mass measuring 0. 5X 0. 5X4cm was removed en masse, and the degenerated disc material in the L4_5 intervertebral space was evacuated in pieces. Microspic examination of the mass was the degenerated nucleus pulposus. Postoperative course was uneventful and the symptoms were minimized in a week along the improvement of neurological deficits.
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