Spontaneous resorption in recurrent intradural lumbar disc herniation

Case report

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✓The authors report a case of spontaneous resorption of intradural disc material in a patient with recurrent intradural lumbar disc herniation and review magnetic resonance (MR) imaging and histopathological findings. Intradural lumbar disc herniation is rare, and most patients with this condition require surgical intervention due to severe leg pain and vesicorectal disturbance. In the present case, however, the recurrent intradural herniated mass had completely disappeared by 9 months after onset. Histological examination of intradural herniated disc tissue demonstrated infiltrated macrophages and angiogenesis within the herniated tissue, and Gd-enhanced MR images showed rim enhancement not only at the initial presentation, but also at recurrence.

The authors conclude that when rim enhancement is present on Gd-enhanced MR images, there is a possibility of spontaneous resorption even though the herniated mass may be located within the intradural space. Moreover, when radiculopathy is controllable and cauda equina syndrome is absent, conservative therapy can be selected.

Abbreviation used in this paper:MR = magnetic resonance.

Article Information

Address reprint requests to: Tsubasa Sakai, M.D., Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan. email: ts2611@hotmail.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative sagittal (left) and axial (right) T1-weighted Gd-enhanced MR images showing an intradural mass with rim enhancement at the L2–3 level.

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    Intraoperative photograph showing the large intradural herniated mass (arrow), which was wrapped with abundant blood vessels and is not adhering to the surrounding tissue.

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    Photomicrograph of a section of the intradural herniated mass showing abundant infiltrated macrophages (dark arrows) and capillaries (white arrows). H & E. Bar = 200 μm.

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    Sagittal (left) and axial (right) T1-weighted MR images obtained 3 months postoperatively showing absence of intradural mass.

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    Sagittal (left) and axial (right) T1-weighted Gd-enhanced MR images obtained 9 months postoperatively showing recurrence of the mass with rim enhancement at the L2–3 level.

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    Sagittal (left) and axial (right) T1-weighted Gd-enhanced MR images obtained 9 months after the recurrence showing complete resolution of the mass.

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