Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis
Jia Chen,1,2 Hai-Jian Ni,1,2 Fei Xue,3 Yun-Shan Fan,1,2 Xi-Fan Li,4 Xian-Zhen Chen,3 Shi-Sheng He1,2 1Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 2Spinal Pain Research Institute,...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-05-01
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| Series: | Journal of Pain Research |
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| Online Access: | https://www.dovepress.com/upper-lumbar-intradural-disc-herniation-a-rare-case-report-and-etiolog-peer-reviewed-fulltext-article-JPR |
| _version_ | 1818600453716312064 |
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| author | Chen J Ni HJ Xue F Fan YS Li XF Chen XZ He SS |
| author_facet | Chen J Ni HJ Xue F Fan YS Li XF Chen XZ He SS |
| author_sort | Chen J |
| collection | DOAJ |
| description | Jia Chen,1,2 Hai-Jian Ni,1,2 Fei Xue,3 Yun-Shan Fan,1,2 Xi-Fan Li,4 Xian-Zhen Chen,3 Shi-Sheng He1,2 1Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 2Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 3Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 4Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of ChinaCorrespondence: Shi-Sheng HeSpinal Pain Research Institute, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail tjhss7418@tongji.edu.cnXian-Zhen ChenDepartment of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail chenxianzheny@126.comBackground: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms.Case Description: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient’s pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up.Conclusion: Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.Keywords: lower back pain, radiating pain, upper lumbar, intradural disc herniation, case report |
| first_indexed | 2024-12-16T12:35:44Z |
| format | Article |
| id | doaj.art-fd06043159d145ee80e05c436bc9bc0b |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-16T12:35:44Z |
| publishDate | 2021-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-fd06043159d145ee80e05c436bc9bc0b2022-12-21T22:31:34ZengDove Medical PressJournal of Pain Research1178-70902021-05-01Volume 141475148165230Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic AnalysisChen JNi HJXue FFan YSLi XFChen XZHe SSJia Chen,1,2 Hai-Jian Ni,1,2 Fei Xue,3 Yun-Shan Fan,1,2 Xi-Fan Li,4 Xian-Zhen Chen,3 Shi-Sheng He1,2 1Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 2Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 3Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 4Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of ChinaCorrespondence: Shi-Sheng HeSpinal Pain Research Institute, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail tjhss7418@tongji.edu.cnXian-Zhen ChenDepartment of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail chenxianzheny@126.comBackground: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms.Case Description: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient’s pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up.Conclusion: Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.Keywords: lower back pain, radiating pain, upper lumbar, intradural disc herniation, case reporthttps://www.dovepress.com/upper-lumbar-intradural-disc-herniation-a-rare-case-report-and-etiolog-peer-reviewed-fulltext-article-JPRlower back painradiating painupper lumbarintradural disc herniationcase report |
| spellingShingle | Chen J Ni HJ Xue F Fan YS Li XF Chen XZ He SS Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis Journal of Pain Research lower back pain radiating pain upper lumbar intradural disc herniation case report |
| title | Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis |
| title_full | Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis |
| title_fullStr | Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis |
| title_full_unstemmed | Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis |
| title_short | Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis |
| title_sort | upper lumbar intradural disc herniation a rare case report and etiologic analysis |
| topic | lower back pain radiating pain upper lumbar intradural disc herniation case report |
| url | https://www.dovepress.com/upper-lumbar-intradural-disc-herniation-a-rare-case-report-and-etiolog-peer-reviewed-fulltext-article-JPR |
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