INTRARADICULAR AND INTRADURAL LUMBAR DISC HERNIATION - EXPERIENCES WITH 9 CASES

BACKGROUND Intraradicular or intradural disc herniation is a very rare complication of spinal degenerative processes. The aim of our study i s to analyze the clinical spectrum, the mechanism, and the treatment o f this acute spinal pathology. METHODS Retrospective clinical examinat ion was performed in nine personal cases of intradural disc herniation : among these, six were associated with lateral perforation, the remai ning three with intradural herniation and ventral perforation. A revie w of the literature concerning mainly the frequency pathogenesis and d iagnosis of intradural disc herniation has also been done. RESULTS Nin e cases of intradural herniations comprise 1.51% of the 593 cases of r uptured lumbar disc that underwent surgery from 1980 to 1992. The site most frequently involved is at level L4-L5, and 30% of patients have previously undergone surgery for lumbar disc herniation. Most patients reported in literature and in our present series have been complainin g of a chronic history of sciatica, complicated later by bilateral neu rologic signs. in the present series, diagnosis was obtained by means of myelography and computerized tomography; magnetic resonance imaging was performed in one case. All patients underwent surgery, reporting excellent results in five cases and good results in the other four. Su rgery was performed either with an interlaminar approach or with a bil ateral laminectomy in cases of ventral perforation. CONCLUSIONS There is no typical neuroradiologic picture of intraradicular herniation, wh ile a total or subtotal block is frequently observed in intradural ven tral perforations. Dural perforation is often an unexpected intraopera tive finding. Surgical treatment is always necessary. Favorable result s are obtained if surgical treatment is carried out before the neurolo gic deficit becomes too pronounced.