Intradural Disc Herniation Diagnosis and Management

Intradural disc herniation represents the extrusion of intervertebral nucleus pulposus through the dura mater into the subdural or subarachnoid space and accounts for less than 1% of all disc herniations. The lumbar region, particularly the L4–L5 level, is most frequently affected, reflecting both biomechanical stress and close dural–ligamentous adhesions. Proposed pathogenetic factors include chronic microtrauma, congenital dural thinning and inflammatory adhesion formation. Clinically, patients present with acute or subacute low back pain, radiculopathy and, in severe cases, signs of cauda equina syndrome such as saddle anaesthesia or bladder dysfunction; cervical intradural herniations may manifest as myelopathy or quadriparesis. Magnetic resonance imaging remains the cornerstone of preoperative diagnosis: characteristic features on T2-weighted sagittal and axial scans include a divided ventral dural line (“Y sign”), a peripheral high-signal “halo” and irregular dural contour. In equivocal cases, invasive discography or advanced diffusion studies can aid differentiation from neoplasm or haematoma. Definitive management is surgical, typically comprising hemilaminectomy or laminectomy, transdural microsurgical removal of the herniated fragment, meticulous dural repair and, where indicated, instrumented fusion. Prompt intervention is associated with favourable neurological recovery, whereas diagnostic delay may result in persistent deficits. Research continues to refine non-invasive imaging criteria, reduce surgical morbidity and elucidate dural breach mechanisms.

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Intradural Disc Herniation Diagnosis and Management publication trend

The graph below shows the total number of articles in intradural disc herniation diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Intradural disc herniation: Protrusion of intervertebral disc material through the dura mater into the intradural space.

Cauda equina syndrome: Compression of lumbar nerve roots causing lower limb weakness, saddle anaesthesia and bladder or bowel dysfunction.

T2-weighted MRI: An imaging sequence in which fluid appears bright, enhancing visualisation of cerebrospinal fluid and soft-tissue anomalies.

Transdural microsurgery: A surgical approach involving dural incision under magnification to access and remove intradural pathology.

References

1. The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra‐Arachnoid Lumbar Disc Herniation. Case Reports in Medicine (2012).
2. Discography aids definitive diagnosis of posterior epidural migration of lumbar disc fragments: case report and literature review. BMC Musculoskeletal Disorders (2017).
3. Intradural disc herniation at L4/5 level causing Cauda equina syndrome. Medicine (2020).
4. Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy. Medicine (2016).