Multispecialty perspective on intradural disc herniation: diagnosis and management - A case report

• Published in: Anesthesia and pain medicine (Korean society of anesthesiologists) 2022-04, Vol.17 (2), p.221-227
• Main Authors: Francio, Vinicius Tieppo, Wie, Christopher S, Murphy, Micheal T, Neal, Matthew T, Lyons, Mark K, Gibbs, Wende N, Strand, Natalie H
• Format: Article
• Language: English
• Subjects: intervertebral disc displacement; low back pain; neurosurgery; pain; Spinal Pain
• ISSN: 1975-5171; 2383-7977
• DOI: 10.17085/apm.21100

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. 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. 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.