Hyeun Sung Kim1, Rabindra L Pradhan2, Nitin Adsul3, Jee-Soo Jang4, Il-Tae Jang1, Seong-Hoon Oh5. 1. Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea. 2. Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Kathmandu Medical College, Kathmandu, Nepal. 3. Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea. Electronic address: no1.nitinadsul@gmail.com. 4. Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Republic of Korea. 5. Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Republic of Korea.
Abstract
BACKGROUND: Intradural disk herniation is a rare entity with <0.3%-1% of all disk herniations and at an L2-L3 level even rarer. The dural defects repairs on ventral aspect are technically challenging and may not be possible after durotomy, so many authors have placed fascia, muscle, or plugging by the hemostatic material. The surgical treatment of intradural disk herniation is usually posterior open surgery with formal durotomy to remove the disk fragments with good to fair results. Poorer outcome occurs in late-presenting cases. CASE REPORT: We report on a 78-year-old man who presented with spontaneous low back pain and bilateral buttock pain aggravated for 1 month with severe walking difficulty without bowel and bladder symptoms. Magnetic resonance imaging revealed disk herniation at the L2-L3 level. He underwent a transforaminal endoscopic removal of intradural disk fragments via the original rent in the anterolateral aspect of the dura, and sealing was performed with dural patch and Gelfoam without any lumbar drain. The patient's symptom significantly improved postoperatively with muscle power improved to grade 5 on day 1 with no cerebrospinal fluid leakage, and he was mobilized with a lumbar orthosis on the first postoperative day. Postoperative and at 6-month follow-up, magnetic resonance imaging revealed adequate decompression and successful sealing of the ventral dural defect. CONCLUSIONS: To our knowledge, this is the first case of transforaminal endoscopic treatment of intradural disk herniation at an L2-L3 level in which good clinical outcomes were obtained and maintained until recent follow-up of 8 months.
BACKGROUND: Intradural disk herniation is a rare entity with <0.3%-1% of all disk herniations and at an L2-L3 level even rarer. The dural defects repairs on ventral aspect are technically challenging and may not be possible after durotomy, so many authors have placed fascia, muscle, or plugging by the hemostatic material. The surgical treatment of intradural disk herniation is usually posterior open surgery with formal durotomy to remove the disk fragments with good to fair results. Poorer outcome occurs in late-presenting cases. CASE REPORT: We report on a 78-year-old man who presented with spontaneous low back pain and bilateral buttock pain aggravated for 1 month with severe walking difficulty without bowel and bladder symptoms. Magnetic resonance imaging revealed disk herniation at the L2-L3 level. He underwent a transforaminal endoscopic removal of intradural disk fragments via the original rent in the anterolateral aspect of the dura, and sealing was performed with dural patch and Gelfoam without any lumbar drain. The patient's symptom significantly improved postoperatively with muscle power improved to grade 5 on day 1 with no cerebrospinal fluid leakage, and he was mobilized with a lumbar orthosis on the first postoperative day. Postoperative and at 6-month follow-up, magnetic resonance imaging revealed adequate decompression and successful sealing of the ventral dural defect. CONCLUSIONS: To our knowledge, this is the first case of transforaminal endoscopic treatment of intradural disk herniation at an L2-L3 level in which good clinical outcomes were obtained and maintained until recent follow-up of 8 months.
Authors: Phattareeya Pholprajug; Tada Wiratapesuporn; Kantang Satayasoontorn; Surapon Atiprayoon; Vit Kotheeranurak Journal: N Am Spine Soc J Date: 2022-06-18