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Intradural Lumbar Disk Herniation and Cauda Equina Syndrome

March 01, 2019

Contributors: Edward M Delsole, MD; Karan Patel, MD; Themistocles Stavros Protopsaltis, MD, FAAOS; Rivka Chinyere Ihejirika, MD; Rivka Chinyere Ihejirika, MD

Intradural lumbar disk herniations (LDHs) are rare, accounting for less than 0.4% of all disk herniations and primarily occurring after lumbar spine surgery. Studies hypothesize that the herniation may propagate from an unrecognized defect in the dura after surgery or as a result of adhesions between the dura and the posterior longitudinal ligament. This video details the etiology, presentation, diagnostic evaluation, and management of intradural LDHs. The video discusses the case presentation of a patient with symptoms of cauda equina and a large intradural LDH observed on MRI 1 year after L2-5 laminectomy and L2-3 decompression, which resulted in no known complications. The patient underwent transforaminal interbody fusion followed by a durotomy, LDH removal, and dural closure. A ventrolateral dural defect was discovered and repaired intraoperatively.

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