Intradural lumbar disc herniation: A rare case

Abstract

A 65-year-old man was admitted with radiating pain in right leg and saddle type anaesthesia with urination, defecation and ejaculation problems. Spinal MRI revealed a disc fragment that hugely extruded towards central spinal channel with marked cranial migration at L4-5 level on the T2 weighted sagittal image. It also demonstrated abrupt loss of continuity of the posterior longitudinal ligament (PLL). Then, he was taken for surgery. After a durotomy was performed, two pieces of cartilagenous tissue were removed en bloc. Three months later, his urination, defecation, ejaculation returned to nearly normal; and postoperative MRI revealed that operative site was clean and there was no residual disc material. We would like to emphasis on two points of MR findings about which increase the suspicious for intradural extension of these disc fragments. The first point is abrupt loss of continuity of the posterior longitudinal ligament. The second point is a sharp beak-like appearance on T2 weighted axial imaging. Prognosis is related to complete removal of the herniated material, cleaning of the intervertebral space, duration and characterization of the symptomatology.