Age / Sex : 65 / F

Chief complaint; right lower extremity radiating pain, sensory change, and weakness

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Courtesy : 윤영철 Young Cheol Yoon, 삼성서울병원 Samsung medical center Seoul hospital

Intradural disc herniation

Discussion

Definition; Intradural disc herniation occur when disc material related to an intervertebral disc hernia penetrates the spinal dura and lies in an intradural extramedullary location.

Epidemiology; Intradural disc herniation correspond to a rare presentation of a common pathology, comprising ~0.28% of all disc herniation.

Clinical presentation; Symptoms are indistinguishable from other types of disc hernias. A higher incidence of cauda equina syndrome has been reported when compared to extradural hernias.

CT findings; Although CT has a known limitation to assess the dural sac and spinal cord, when gas is present in the degenerated intervertebral disc space (vacuum phenomenon), this can migrate to the herniated mass and delineate the intradural component of a hernia.

MRI findings; the intradural herniated disc may be delineated protruding into the dural sac. However, it can be difficult to differentiate from an intradural tumor, particularly if the disc material has migrated away from the donor disc. Post-contrast images will delineate an incomplete ring enhancement (chronic granulation tissue and peripheral neovascularization), helping to distinguish it from tumors.

Differential diagnosis; intradural extramedullary tumors including spinal meningioma, spinal schwannoma, and spinal neurofibroma

Reference (https://radiopaedia.org/articles/intradural-disc-herniation)