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J Crit Spine Cases 2012 Nov; 5(2): 29-33
Intradural Lumbar Disc Herniation Causing Cauda Equina Syndrome: The Usefulness of MR Myelography
Kyung-Chul Choi, MD, PhD, Hyeong-Ki Shim, MD and Yong Ahn, MD, PhD
Department of Neurosurgery, Seoul Wooridul Spine Hospital, Seoul, Korea

Intradural lumbar disc herniation is rare disease entity. It is difficult to diagnose it preoperatively despite various neuroradiologic diagnostic modalities including myelography, computerized tomography, computerized tomography myelography, and magnetic resonance image. The authors present two cases of intradural lumbar disc herniation causing cauda equina syndrome and discuss the usefulness of magnetic resonance myelography in the diagnosis of intradural lumbar disc herniation. Two patients presented with the sudden onset of cauda equina syndrome. In the first case, our tentative diagnosis was a large extradural disc herniation on magnetic resonance image. However, magnetic resonance myelogram included various source images, which demonstrated that the intradural disc compressed the cauda equina ventrally and had migrated cranially in the dural sac. In the second case, while only an extradural disc fragment seemed to compress the dural sac on magnetic resonance image, magnetic resonance myelography clearly showed that the intradural disc fragment compressed rootlets in the dural sac. After durotomy, intradural disc fragments were completely removed without incident in two patients. Magnetic resonance myelography demonstrates several special findings for intradural lumbar disc herniation which has marginal irregularity, narrowing with acute angle of the dural sac, and island phenomenon. Magnetic resonance myelography can be an excellent adjuvant diagnostic modality in the diagnosis of intradural lumbar disc herniation.

Cauda equina syndromeㆍIntradural disc herniationㆍMagnetic resonance myelography
J Crit Spine Cases 2012 Nov; 5(2): 29-33

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