背景:占椎间盘突出症的不到0.4%,硬膜内腰椎间盘突出症(ILDH)是一种罕见的现象,主要被描述为腰椎手术后的并发症。据推测,在初次手术后或由于硬脑膜和后纵韧带之间的粘连,疝可能会从未识别的硬脑膜缺损中传播。本报告探讨了病因,介绍,诊断评估,和ILDH的治疗以及一例病例报告和显微外科手术视频。
方法:一名67岁患者,1年前接受了L2-5椎板切除术和L2-3减压术,无已知并发症,表现为下腰痛和右腿放射,臀部,腹股沟疼痛1个月。体格检查无麻木或无力。磁共振成像显示较大的ILDH。进行了椎间孔间融合术,然后进行了硬体切开术,ILDH移除,和硬脑膜封闭。在手术过程中发现并修复了腹侧硬脑膜缺损。
结论:治疗ILDH的方法是椎板切除术加背侧硬骨切开术。因为ILDH在文献中很少被描述,理解它的表达对于及时识别和管理至关重要。
BACKGROUND: Accounting for less than 0.4% of disc herniations, intradural lumbar disc herniations (ILDHs) are a rare occurrence primarily described as a complication after lumbar spine surgery. It is speculated that the herniation may propagate intradurally from either an unrecognized dural defect after initial surgery or as a result of adhesions between the dura and posterior longitudinal ligament. This report explores the etiology, presentation, diagnostic evaluation, and treatment of ILDH along with a case report and microsurgery video.
METHODS: A 67-year-old patient who 1 year earlier had undergone an L2-5 laminectomy and L2-3 decompression with no known complications presented with low back pain and radiating right leg, buttock, and groin pain for 1 month. Physical examination indicated no numbness or weakness. Magnetic resonance imaging demonstrated a large ILDH. A transforaminal interbody fusion was performed followed by a durotomy, ILDH removal, and dural closure. A ventral dural defect was found and repaired during the procedure.
CONCLUSIONS: The treatment for ILDH is laminectomy with dorsal durotomy. Because ILDH has rarely been described in literature, understanding its presentation is crucial for prompt identification and management.