Intradural lumbar disc herniations associated with cauda equina syndrome: Report of two cases and review of literature

The majority of symptomatic lumbar herniated disc are located in a posterolateral position with resultant nerve root compression. although caudal, rostral and lateral migrations of disc fragments are common, intradural lumbar disc herniation of an extruded free fragment is a rare pathological entity, and much rarer when associated with cauda equina syndrome. We treated two cases: a 79-year-old woman with a 2-year history of low back pain, bilateral sciatica and cauda equina syndrome and a 63-year-old man with lower back pain and cauda equina syndrome non-responding to therapies. Magnetic resonance Mri imaging revealed a central L1-L2 disc protrusion for the woman and a posterior epidural migration of a free disc fragment from L3-L4 for the man. in both cases, patients underwent standard laminectomy and removal of all the fragments of the disc. intraoperatively we observed a dorsal sac swollen and immobile. Postoperatively, the patient†s radicular symptoms completely resolved. First patient had a full recovery of motor, sensory and urinary functions after 4 months, while the second one after 2 years. after surgery, patient†s radicular symptoms were gradually resolved and were discharged with clear signs of motor and sensory function recovery. The palpation of the intradural mass through the dural sac is very important especially when intraoperative findings are different than the radiological imaging. in such cases, a wide decompressive laminectomy with removal of the extruded fragment is recommended.