gms | German Medical Science

Objective: Intradural disc herniation is a rare condition. An incidence of intradural disc herniation in between 0,26 -0,30% of all herniated discs has been reported. Only 3% of all intradural disc herniation are found in the cervical region. Adhesion between dura sac and posterior longitudinal ligament is the most common reason for intradural disc herniation.

Method: Here, we present a rare case of nontraumatic intradural cervical disc herniation and results of review from literature.

Results: A 45-year-old male presented with a one day history of Brown-Sequard-Syndrom, gait disturbance, areflexia and also cervicobrachialgia on the right side. The patient had no trauma. The MRI revealed a cervical disc herniation on the C 4/5 level. The MRI showed no signs of an intradural disc herniation. The patient underwent an emergency surgery. Via an approach of the anterior cervical spine a nucleotomy was performed. After opening the posterior longitudinal ligament a dura tear and an intradural disc fragment were observed. The disc fragment was removed and a dura repair was performed. Moreover, an anterior interbody fusion was undertaken with a cervical prosthesis. Postoperatively, the neurological status of the patient improved rapidly and the cervicobrachialgia was not present any more. However, six days after surgery the patient complained about dysphagia. A swelling on the right side neck was seen. The MRI showed an extensive dural fistula. A second surgery was performed. Six months after surgery the patient had no more paresis and gait disturbance. He reported only a hyperalgesia on the left side except in his face.

25 cases of intradural cervical disc herniation have been reported in the literature. In one further case the disc herniation was on the C7/Th1 level. In most cases (12/25) the segment C5/6 was affected. The patients ranged in age from 24 to 70 years. 24 patients were treated surgically. In two cases the therapy could not be indicated. 23 patients showed a recovery of complains and neurological deficits. Only one patient suffered from a deterioration of neurological deficits. In two cases the outcome could not be indicated.

Conclusions: Intradural cervical disc herniation is rare. The neurological deficits are more severe than in the extradural disc herniation. The MRI with Gadolinium is the method of choice in the diagnostic of intradural cervical disc herniation. However, the diagnosis can often secured only intraoperatively. A contemporary surgery is associated with a good outcome.

Note: Hajrullah Ahmeti and Alexander Doukas contributed equally.