J Korean Neurosurg Soc.  2012 Aug;52(2):156-158. 10.3340/jkns.2012.52.2.156.

Intradural Migration of a Sequestrated Lumbar Disc Fragment Masquerading as a Spinal Intradural Tumor

• Kim HS
• Eun JP
• Park JS

• KMID: 2190557
• DOI: http://doi.org/10.3340/jkns.2012.52.2.156

Abstract

Intervertebral intradural lumbar disc herniation (ILDH) is a quite rare pathology, and isolated intradural lumbar disc herniation is even more rare. Magnetic resonance imaging (MRI) may not be able to reveal ILDHs, especially if MRI findings show an intact lumbar disc annulus and posterior longitudinal ligament. Here, we present an exceedingly rare case of an isolated IDLH that we initially misidentified as a spinal intradural tumor, in a 54-year-old man hospitalized with a 2-month history of back pain and right sciatica. Neurologic examination revealed a positive straight leg raise test on the right side, but he presented no other sensory, motor, or sphincter disturbances. A gadolinium-enhanced MRI revealed what we believed to be an intradural extramedullary tumor compressing the cauda equina leftward in the thecal sac, at the L2 vertebral level. The patient underwent total L2 laminectomy, and we extirpated the intradural mass under microscopic guidance. Histologic examination of the mass revealed a degenerated nucleus pulposus.

Keyword

Intradural disc herniation; Spinal intradural tumor; Magnetic resonance imaging

MeSH Terms

Back Pain
Cauda Equina
Humans
Laminectomy
Leg
Longitudinal Ligaments
Magnetic Resonance Imaging
Middle Aged
Neurologic Examination
Sciatica

Figure

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  Fig. 1 Preoperative MRI. A : A 10×23 mm sized isointense mass-like lesion on sagittal T1-weighted image (arrow) B : Inhomogenous signal intensity on T2-weighted image.

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  Fig. 2 Gadolinium-enhanced axial image shows peripherally enhanced of the lesion.

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  Fig. 3 Intraoperative photograph. Yellowish mass occupying the thecal sac (white arrow) and peripheral displacement of the adherent cauda equine nerve roots (black arrow).

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