Intradural Migration of a Sequestrated Lumbar Disc Fragment Masquerading as a Spinal Intradural Tumor

Intervertebral intradural lumbar disc herniation (ILDH) is a quite rare pathology, and isolated intradural lumbar disc herniation is even more rare. Magnetic resonance imaging (MRI) may not be able to reveal ILDHs, especially if MRI findings show an intact lumbar disc annulus and posterior longitudinal ligament. Here, we present an exceedingly rare case of an isolated IDLH that we initially misidentified as a spinal intradural tumor, in a 54-year-old man hospitalized with a 2-month history of back pain and right sciatica. Neurologic examination revealed a positive straight leg raise test on the right side, but he presented no other sensory, motor, or sphincter disturbances. A gadolinium-enhanced MRI revealed what we believed to be an intradural extramedullary tumor compressing the cauda equina leftward in the thecal sac, at the L2 vertebral level. The patient underwent total L2 laminectomy, and we extirpated the intradural mass under microscopic guidance. Histologic examination of the mass revealed a degenerated nucleus pulposus.

Clinical Characteristics and Surgical Results of Spinal Intradural Tumor

STUDY DESIGN: A retrospective study about spinal intradural tumor. OBJECTIVES: We analyzed clinical symptom, findings of MRI, and surgical outcome of spinal intradural tumor. SUMMARY OF LITERATURE REVIEW: Intradural tumors are not commonly reported and they show non-specific clinical features. MATERIALS AND METHODS: In this study, 18 patients who underwent surgical treatment and radiologically and pathologically diagnosed as spinal intradural tumor from 1997 to 2009 were reviewed. We evaluated pain, neurological symptoms, location of tumor as well as degrees of signal intensity and its enhancement of MRI(T1 and T2). And clinical outcomes were analyzed according to Klekamp-Samii scoring system and Visual Analogue Scale(VAS). RESULTS: All patients were clinically suffered from back pain and radiating pain of lower extremity including 3 patients with neurological symptoms. We radiologically found single tumor in 16 cases and masses more than two lesion in 2 cases. 1 case was located on cord level(T7), 14 cases cauda equine level, and 3 cases sacral level. We performed laminectomy in 18 cases and posterior instrumentation was applied to 8 cases. In clinical features, mean Klekamp-Samii score was improved from 21.6 to 23.5(p<0.05) and VAS was recovered from 5.2 to 3.0 (p<0.05). CONCLUSIONS: Spinal intradural tumor has non-specific clinical symptoms. Therefore we should perform MRI to find intradural tumor and active management including surgical treatment should be performed due to clinically good results.

Evaluation of Ultrasonic Aspiration in the Surgical Removal of Spinal Intradural Tumors

The cavitron ultrasonic surgical aspirator(CUSA) has been used for the surgical removal of 26 cases of spinal intradural tumors. In 26 patients, total removal was possible in 77% and there was no neurological deterioration due to surgical removal using CUSA. 21 of 26 patients(84%) showed neurological improvement at long term follow-up examination. The cavitron ultrasonic surgical aspirator had advantages in the surgical removal of spinal intradural tumors, as follows:1) precise removal of tumor without excessive meahcnical manipulation of normal tissue;2) rapidity of action relative to the consistency of the tissue;3) direct visualization of the tissue being removed and good proprioceptive feedback for the surgeon;4) preservation of large vessel and very little bleeding;5) lack of thermal injury. The limitation of CUSA was obscuring of operation field by large and straight hand piece.