Intradural lumbar disc herniation with cauda equina syndrome: Case report and recent advances
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ABSTRACT:
SUBMITTER: Loya V
PROVIDER: S-EPMC10951713 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
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Project description:IntroductionIntradural disc herniation (IDH) is a rare complication which comprises 0.27% of all herniated intervertebral discs. We are reporting a case of lumbar intradural disc herniation at the L4-L5 levels highlighting challenges in establishing clinical diagnosis and surgical approach involving a transdural microsurgery approach.Presentation of caseA 38-year-old gentleman was presented with left radicular low back pain without motoric and autonomic involvement admitted to our neurosurgical service. Spine MRI showed an intradural, extra-axial spinal mass.DiscussionLumbar IDH is a rare pathology thus often initially diagnosed as other more common conditions. In our case, the IDH diagnosis was confirmed during surgery as the radiological examination results mimic intradural extra-axial tumor. During surgery, a hard irregular white mass was found shortly after dural incision. Histopathological results showed chondrocytes, fibrotic and necrotic appearances consistent with the diagnosis of disc herniation. Postoperatively, the patient showed improvement and pain alleviation.ConclusionWe observed the beak sign which is one of the important features of IDH imaging. Surgery-wise, the challenge of dissecting the anterolateral part of the duramater from the annulus fibrosus of the intervertebral disc should be noted by the performing surgeon.
| S-EPMC7498703 | biostudies-literature
Project description:IntroductionCauda equina syndrome (CES) is most caused by lumbar disc herniation, and the associated treatment involves prompt surgical decompression. Rarer causes of CES include perineural (Tarlov) cysts.Clinical presentationA 62-year-old female with history of rheumatoid arthritis, hip and knee replacements, and chronic low back pain presented with worsening back pain, left leg weakness and pain for 6 weeks, and bowel/bladder incontinence with diminished sensation in the perianal region for 24 h prior to presentation. MRI demonstrated severe spinal stenosis at L4-S1, central disc herniation at L5-S1, and compression of the cauda equina, consistent with CES. A lumbar decompression was performed. Patient did well at 2-week follow up, but presented 5 weeks post-discharge with increased left leg pain/weakness and genitalia anesthesia. Imaging was unremarkable. Two months later, the patient presented with diminished sensation in the buttocks and bilateral lower extremities and bowel/bladder incontinence. Imaging demonstrated a large cystic presacral mass with involvement of the left sciatic foramen and S3 neural foramen. A team of plastic, orthopedic, and neurological surgeons performed an S3 sacral laminectomy, foraminotomy, partial sacrectomy, and S3 rhizotomy, and excision of the large left hemorrhagic pudendal mass. Final pathology demonstrated a perineural cyst with organizing hemorrhage. On follow-up, the patient's pain and weakness improved.ConclusionCES-like symptoms were initially attributed to a herniated disk. However, lumbar decompression did not resolve symptoms, prompting further radiographic evaluation at two separate presentations. This represents the first reported case of a pudendal tumor causing symptoms initially attributed to a herniated disc.
| S-EPMC9345956 | biostudies-literature
Project description:BackgroundIntradural herniation (IDH) or transdural disc herniation is a rare presentation of lumbar disc disease. Preoperative imaging findings should be carefully and thoroughly interpreted. Although imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) are readily available, a definitive diagnosis cannot be made based solely on these modalities. Operative procedures must be planned to prevent unexpected complications.Case descriptionA 67-year-old man presented with right lower extremity weakness and numbness with bowel and bladder involvement for 2 weeks, after falling from a standing position. MRI revealed a large herniated disc at L2-L3, which was suspected to be IDH. Posterior discectomy and interbody fusion were also performed. Intraoperative findings revealed no disc material in the epidural space or dural sac tenting. Dorsal midline durotomy was performed, and a mass-like lesion was found and resected. Subsequently, pathological analysis revealed disc tissue with evidence of moderate chronic inflammation and a focal increase in fibrosis. The patient was discharged without complications.Results outcomeLower extremity strength improved to grades IV-V, accompanied by a return to normal bowel and bladder function within 1 month, without any wound complications. Lower extremity strength recovered fully to grade V, and the patient started walking independently within 6 months.ConclusionsA large disc herniation, suspected to be an IDH, should be thoroughly investigated by carefully reviewing MRI scans before proceeding with any surgical procedure to prevent unexpected situations. Nonetheless, preoperative imaging alone does not ensure a definitive diagnosis, and the differential diagnosis must include other mass-like lesions. Intraoperative findings and pathological reports are essential for definitive diagnosis of IDH.
| S-EPMC9256825 | biostudies-literature
Project description:Spinal sparganosis of the cauda equina has been rarely reported. A 54-year-old man presented at the hospital after having experienced lower back pain for 10 months, progressive weakness and numbness of the left leg for 4 months, and urinary incontinence for 3 weeks. Magnetic resonance imaging of the lumbosacral spine revealed a heterogeneous enhancing mass at the T12-S1 level. Spinal sparganosis was diagnosed by histological examination and molecular identification of the parasite in the tissue section. The patient was treated with a high dose of praziquantel because the parasitic mass was only partially removed and symptoms worsened following surgery.
| S-EPMC7790082 | biostudies-literature
Project description: Not available
| S-EPMC6583408 | biostudies-literature
Project description:Study Design Case report. Objective Present a case of Foix-Alajouanine syndrome that presented as acute cauda equina syndrome and discuss the pathophysiology and management. Methods An adult male patient developed sudden onset of back pain and leg pain with weakness of the lower limbs and bladder/bowel dysfunction typical of cauda equina syndrome. Emergency magnetic resonance imaging revealed no compressive lesion in the spine but showed tortuous flow voids and end-on blood vessels in the peridural region suggesting spinal arteriovenous malformation resulting in Foix-Alajouanine syndrome. Results The case was managed by endovascular embolization with excellent results. The pathophysiology, imaging features, management, and literature review of the syndrome is discussed. Conclusion The authors conclude that this condition may be an important differential diagnosis for cauda equina syndrome.
| S-EPMC4229378 | biostudies-other
Project description:IntroductionMalignant lymphoma (ML) can involve the central nervous system either primarily or by secondary spread, which tends to occur late in the disease as part of widespread dissemination. Lymphoma presenting as primary tumors of the spinal cord is extremely uncommon. Primary spinal lymphoma if detected early can have a good prognosis with no relapse after effective treatment.Case presentationA 32 years old male patient presented with the symptoms of impending cauda equina syndrome which was managed with surgery and chemotherapy. The patient was successfully treated without the relapse of his condition at his 6 months follow-up scan.Discussion: Primary spinal non-Hodgkin lymphoma is a rare entity among extranodal non-Hodgkin lymphoma. MRI is usually non-confirmatory and needs immunohistochemistry for the correct diagnosis. R-CHOP regimen is the standard chemotherapy regimen. Surgical decompression is required in cases of impending neurological injury along with radiotherapy.ConclusionPrimary spinal epidural diffuse large B-cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and symptoms of impending cauda equina syndrome. It is important to early detect and treat the disease to prevent permanent neurological injury and metastasis.
| S-EPMC9661642 | biostudies-literature
Project description:Abscesses involving the spine are usually located in the epidural space. In rare circumstances, intradural spinal abscesses can occur, typically in the setting of tuberculosis or other predisposing systemic conditions. In this illustrated case report, we discuss the imaging and intraoperative findings of an otherwise healthy patient with an intradural abscess of the cauda equina caused by Staphylococcus aureus. Although rare, intradural spinal abscesses can occur in the absence of typical "red flags" for infection, and a bacterial abscess should be considered in the differential diagnosis of intradural spinal cystic enhancing lesions.
| S-EPMC6362506 | biostudies-literature
Project description:To date, only a few reports have described the regression of lumbar disc herniation, which may be because of a failure to follow up patients treated conservatively. We report a case of a 25-year-old man who presented with a 2-month history of pain and soreness owing to lumbar disc herniation. He was managed conservatively, and his presenting symptoms and scoliosis gradually decreased over approximately 5 months. Two years later, he returned unexpectedly and was advised to undergo magnetic resonance imaging, which revealed regression of the disc herniation; the patient also confirmed that the pain had not recurred. After 8 months, he underwent repeat magnetic resonance imaging, and the findings pertaining to disc herniation were normal. Our findings suggest that previous cases should be retrospectively studied to establish a prediction model for the outcomes of conservative treatment in patients with lumbar disc herniation. We also emphasize the significance of selecting suitable patients for conservative treatment to obtain the best therapeutic outcomes. The CARE guidelines have been followed in the reporting of this case.
| S-EPMC8191079 | biostudies-literature
Project description:Intradural spinal tumors are rare tumors of the central nervous system. Due to the eloquence of the spinal cord and its tracts, the compact architecture of the cord and nerves, and the infiltrative nature of some of these tumors, surgical resection is difficult to achieve without causing neurological deficits. Likewise, chemotherapy and radiotherapy are utilized more cautiously in the treatment of intradural spinal tumors than their cranial counterparts. Targeted therapies aimed at the genetic alterations and molecular biology tailored to these tumors would be helpful but are lacking.Here, we review the major types of intradural spinal tumors, with an emphasis on genetic alterations, molecular biology, and experimental therapies for these difficult to treat neoplasms.
| S-EPMC5961256 | biostudies-literature