Introduction

Accounting for an estimated 1.10-1.76% of all lumbar herniations, lumbar intradural disc herniation (IDH) occurs primarily in males during the fourth to fifth decades of life. While not validated, congenital lumbar spinal stenosis (CLSS) is implicated as one precipitating factor for IDH.

Case report

We report 28-year-old Hispanic female with CLSS, severe obesity, and degenerative disk disease, with a history of minimally invasive surgical (MIS) decompression for a large paracentral L4-5 disc herniation at 25. After three years, the patient developed sudden burning dysesthesias in the L4-5 dermatomes bilaterally and temporary leg weakness. Lumbar magnetic resonance imaging exhibited severe L4-5 spinal stenosis, and the patient underwent repeat MIS decompression, which again provided her with adequate symptom resolution. However, 20 days postoperatively she developed cauda equina syndrome with anal dysfunction, and bilateral leg and foot weakness. Upon open surgical exploration we discovered a tense L4-5 dural protrusion. After a dorsal durotomy, a large IDH with a ventral dural tear was identified. Subsequent to adequate debulking of the IDH, the ventral tear was repaired, and an expansile duraplasty was performed. Overall, the patient's bladder and bowel function, pain, hypoesthesia, and motor strength all improved. Two weeks after surgery she presented with a lumbar pseudomeningocele that was managed conservatively.

Conclusion

This report not only highlights an atypical presentation of IDH and is the first case of CLSS linked with IDH, lending support to the hypothesis that CLSS can lead to IDH, but also provides a comprehensive review of IDHs.

中文翻译：

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先天性腰椎管狭窄症的硬膜内椎间盘突出症

介绍

估计占所有腰椎突出症的 1.10-1.76%，腰椎硬膜内椎间盘突出症 (IDH) 主要发生在 4 至 50 岁的男性中。虽然未经证实，但先天性腰椎管狭窄症 (CLSS) 被认为是 IDH 的一个诱发因素。

案例报告

我们报告了一名患有 CLSS、严重肥胖和退行性椎间盘疾病的 28 岁西班牙裔女性，在 25 岁时曾因 L4-5 大中央旁椎间盘突出症进行微创手术 (MIS) 减压。三年后，患者出现双侧L4-5皮节突然烧灼感和暂时性腿部无力。腰椎磁共振成像显示严重的 L4-5 椎管狭窄，患者接受了重复 MIS 减压，这再次为她提供了足够的症状解决。然而，术后 20 天，她出现了伴有肛门功能障碍和双侧腿和足部无力的马尾神经综合征。在开放式手术探查中，我们发现了一个紧张的 L4-5 硬脑膜突出。在背侧硬脑膜切开术后，发现了一个带有腹侧硬脑膜撕裂的大 IDH。在对 IDH 进行充分减容后，修复了腹侧撕裂，并进行了扩张性硬脑膜成形术。总体而言，患者的膀胱和肠道功能、疼痛、感觉减退和运动强度均有所改善。手术两周后，她出现腰椎假性脑脊膜膨出，保守治疗。

结论

本报告不仅强调了 IDH 的非典型表现，是首例与 IDH 相关的 CLSS，支持了 CLSS 可导致 IDH 的假设，而且对 IDH 进行了全面回顾。