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Intradural sequestration of a L3–L4 herniated intervertebral disc. Case report and literature review

https://doi.org/10.24412/1683-3295-2025-27-1-99-105

Аннотация

The issues of etiology, pathogenesis, diagnosis and surgical treatment of intradural sequestration of herniated intervertebral discs are poorly reviewed in the world literature. This pathology occurs in 0.26–0.30 % of cases of all intervertebral disc herniations. The basis of pathogenesis is scar-adhesive changes in the spinal canal, leading to dense fusion of the dura mater with the posterior longitudinal ligament and collapse of the ventral epidural space. The main clinical manifestations are long-term pain in the lumbar spine with possible radicular symptoms. There was also a high incidence of acute caudal radicular ischemia (29 % of cases). An important factor in the differential diagnosis of intradural sequestration of intervertebral discs and intradural extramedullar neoplasms are neuroimaging phenomena (hawk-beak sign, Y-sign, ring enhancement) observed on magnetic resonance imaging in the native mode and with intravenous contrast enhancement. The correct preoperative diagnosis and, as a result, competent planning of surgical intervention are the keys to a favorable clinical outcome in this group of patients.

The article describes a clinical case of 55-year-old patient treatment who underwent surgery in 2023 to remove an intradural sequestration of a herniated intervertebral disc at the L3–L4 level. An overview of the world literature is also presented, and the features of this pathology important for medical practice are discussed.

Об авторах

M. A. Nekrasov
N.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department
Россия

8 Leninskiy Ave., Moscow 119049



D. S. Glukhov
N.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department
Россия

Glukhov Dmitry Sergeevich.

8 Leninskiy Ave., Moscow 119049



V. V. Babenkov
N.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department
Россия

8 Leninskiy Ave., Moscow 119049



E. F. Abdulrahman
Peoples’ Friendship University of Russia n. a. Patrice Lumumba
Россия

6 Miklukho-Maklaya St., Moscow 117198



V. M. Nekrasov
Ivanovo State Medical University, Ministry of Health of Russia
Россия

8 Sheremetyevskiy Ave., Ivanovo 153012



Список литературы

1. Negovetić L., Cerina V., Sajko T. et al. Intradural disc herniation at the T1–T2 level. Croat Med J 2001;42(2):193–5.

2. Cheng Ch.-H., Chang Ch.-Ch., Lin H.-L. et al. Intradural lumbar disc herniation: a case report and literature review. Heliyon 2022;8(12):e12257. DOI: 10.1016/j.heliyon.2022.e12257

3. Schisano G., Franco A., Nina P. Intraradicular and intradural lumbar disc herniation: experiences with nine cases. Surg Neurol 1995;44(6):536–43. DOI: 10.1016/0090-3019(95)00248-0

4. Epstein N.E., Syrquin M.S., Epstein J.A. et al. Intradural disc herniations in the cervical, thoracic, and lumbar spine: report of three cases and review of the literature. J Spinal Disord 1990;3(4):396–403.

5. Choi J.Y., Lee W.S., Sung K.H. Intradural lumbar disc herniation – is it predictable preoperatively? A report of two cases. Spine J 2007;7(1):111–7. DOI: 10.1016/j.spinee.2006.02.025

6. Dandy W.E. Serious complication of ruptured intervertebral disk. JAMA 1942;119(6):474–7.

7. Guan Q., Xing F., Long Y. et al. Cervical intradural disc herniation: a systematic review. J Clin Neurosci 2018;48:1–6. DOI: 10.1016/j.jocn.2017.10.024

8. Lee S.T., Fairholm D. Intradural rupture of lumbar intervertebral disc. Can J Neurol Sci 1983;10(3):192–4. DOI: 10.1017/s0317167100044905

9. Yildizhan A., Paşaoğlu A., Okten T. et al. Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment. Acta Neurochir (Wien) 1991;110(3–4):160–5. DOI: 10.1007/BF01400685

10. Clatterbuck R.E., Belzberg A.J., Ducker T.B. Intradural cervical disc herniation and Brown-Séquardʼs syndrome. Report of three cases and review of the literature. J Neurosurg 2000;92(2 Suppl): 236–40. DOI: 10.3171/spi.2000.92.2.0236

11. Hsieh J.H., Wu C.T., Lee S.T. Cervical intradural disc herniation after spinal manipulation therapy in a patient with ossification of posterior longitudinal ligament: a case report and review of the literature. Spine (Phila Pa 1976) 2010;35(5):E149–51. DOI: 10.1097/BRS.0b013e3181bee8a7

12. Süzer T., Tahta K., Coşkun E. Intraradicular lumbar disc herniation: case report and review of the literature. Neurosurgery 1997;41(4):956–8. DOI: 10.1097/00006123-199710000-00037

13. DʼAndrea G., Trillò G., Roperto R. et al. Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature. Neurosurg Rev 2004;27(2):75–80. DOI: 10.1007/s10143-003-0296-3

14. Hidalgo-Ovejero A.M., García-Mata S., Gozzi-Vallejo S. et al. Intradural disc herniation and epidural gas: something more than a casual association? Spine (Phila Pa 1976) 2004;29(20):E463–7. DOI: 10.1097/01.brs.0000142433.21912.0d

15. Sasaji T., Horaguchi K., Yamada N. et al. The specific sagittal magnetic resonance imaging of intradural extra-arachnoid lumbar disc herniation. Case Rep Med 2012;2012:383451. DOI: 10.1155/2012/383451

16. Börm W., Bohnstedt T. Intradural cervical disc herniation. Case report and review of the literature. J Neurosurg 2000;92(2 Suppl):221–4.

17. Wasserstrom R., Mamourian A.C., Black J.F. et al. Intradural lumbar disk fragment with ring enhancement on MR. AJNR Am J Neuroradiol 1993;14(2):401–4.

18. Koivukangas J., Tervonen O. Intraoperative ultrasound imaging in lumbar disc herniation surgery. Acta Neurochir (Wien) 1989; 98(1–2):47–54. DOI: 10.1007/BF01407176


Рецензия

Для цитирования:


Nekrasov M.A., Glukhov D.S., Babenkov V.V., Abdulrahman E.F., Nekrasov V.M. Intradural sequestration of a L3–L4 herniated intervertebral disc. Case report and literature review. Нейрохирургия. 2025;27(1):99-105. https://doi.org/10.24412/1683-3295-2025-27-1-99-105

For citation:


Nekrasov M.A., Glukhov D.S., Babenkov V.V., Abdulrahman E.F., Nekrasov V.M. Intradural sequestration of a L3–L4 herniated intervertebral disc. Case report and literature review. Russian journal of neurosurgery. 2025;27(1):99-105. https://doi.org/10.24412/1683-3295-2025-27-1-99-105

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ISSN 1683-3295 (Print)
ISSN 2587-7569 (Online)
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