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KMID : 1155520220170020221
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Anesthesia and Pain Medicine
2022 Volume.17 No. 2 p.221 ~ p.227
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Multispecialty perspective on intradural disc herniation: diagnosis and management - A case report -
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Francio Vinicius Tieppo
Wie Christopher S.
Murphy Micheal T.
Neal Matthew T.
Lyons Mark K.
Gibbs Wende N.
Strand Natalie H.
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Abstract
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Background: Intradural disc herniation (IDH) is a very rare and challenging diagnosis, with an estimated incidence of less than 1.5%. The pathogenesis of IDH remains uncertain. Definitive management remains surgical; however, some cases may initially be managed non-surgically.
Case: A middle-aged male with presented with acute right-sided lumbar radiculopathy following heavy lifting. History was significant for prior lumbar disc herniation managed non-surgically. Lumbar MRI demonstrated a large disc herniation. The patient was initially treated non-surgically with epidural steroid injections. At 4-months, he re-injured and follow-up images demonstrated the herniated disc penetrating the dura and the diagnosis of intradural disc herniation.
Conclusions: The present case is rare because the IDH occurred at the L3-4 level and resulted in unilateral radiculopathy without cauda-equina symptoms and occurred in the absence of prior surgery. This patient was initially treated non-surgically with satisfactory relief, however, reinjury led to progression of IDH with new neurological deficits necessitating surgery.
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KEYWORD
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Intervertebral disc displacement, Neurosurgery, Pain, Low back pain
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