J Korean Soc Spine Surg.  2014 Sep;21(3):134-138. 10.4184/jkss.2014.21.3.134.

Sequestrated Intradural Disc Herniation Around Couns Medullaris: A Case Report

• Lee J
• Seo WS
• Park YS
• Oh YH

• KMID: 2144776
• DOI: http://doi.org/10.4184/jkss.2014.21.3.134

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To report a rare case of intradural disc herniation (IDH) around conus medullaris. SUMMARY OF LITERATURE REVIEW: IDH is rare with an incidence of less than 1% of all lumbar disc herniations. It is important to differentiate IDH from other condition with accurate diagnosis and subsequent surgical treatment. IDH has a higher risk of neurologic deficit, like conus medullaris syndrome and cauda equina syndrome.
MATERIALS AND METHODS
A 62 year-old male was affected by lumbar back pain radiating to the anterolateral aspect of the right thigh for 5 days. MRI showed a mass that existed on the anterior portion of the conus medullaris. We performed partial laminectomy at the L1-L2level. The mass located anteriorly in the intradural space was eliminated after durotomy by a posterior approach.
RESULTS
We confirmed the IDH for histopathology.
CONCLUSIONS
IDH usually needs accurate differential diagnosis. Preoperative MRI scans are necessary to differentiate IDH from other intradural lesions. The confirmative diagnosis can be done only in the operative field.

Keyword

Intradural disc herniation; Conus medullaris

MeSH Terms

Back Pain
Conus Snail
Diagnosis
Diagnosis, Differential
Humans
Incidence
Laminectomy
Magnetic Resonance Imaging
Male
Neurologic Manifestations
Polyradiculopathy
Spinal Cord Compression
Thigh

Figure

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  Fig. 1. Preoperative AP (A) and lateral (B) x-rays. Intervertebral disc space of L1-2 is narrower than other intervertebral disc spaces.

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  Fig. 2. T1- and T2-weighted images in non-contrast sagittal and axial MRI (T1WI) (A, B). Gadolinium-enhanced T1-weighted MRI shows ring enhancement of the mass(C).

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  Fig. 3. Intraoperative clinical photo shows intradural egg-shaped mass after dural incision(A, B).

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  Fig. 4. H-E stained histologic findings show degenerative disc. (A) original magnification x 40, (B) original magnification x 200.

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