open access

Vol 51, No 2 (2017)
Reviews
Submitted: 2016-08-26
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Transdural herniated lumbar disc disease with muscle patch for closure of durotomy – A Brief review of literature

Harsha A. Huliyappa, Rakesh Kumar Singh, Sunil Kumar Singh, Manish Jaiswal, Somil Jaiswal, Chhitij Srivastava, Balkrishna Ojha, Anil Chandra, Satnam Chhabra
DOI: 10.1016/j.pjnns.2016.12.002
·
Neurol Neurochir Pol 2017;51(2):149-155.

open access

Vol 51, No 2 (2017)
Reviews
Submitted: 2016-08-26

Abstract

Purpose

Intradural migration of disc (IDMD) is a rare clinical entity accounting for 0.27–0.33% of all herniated disc diseases. Flimsy or dense adhesion between the ventral dural surface and the opposing posterior longitudinal ligament (PLL) is the principal pathology for intradural migrated disc. The most commonly affected lumbar segments are L4-5 (55%), L3-4 (16%), L5-S1 (10%) and less commonly L2L3 and L1L2. No imaging feature is characteristic and the management protocol of durotomy via an endoscopic method is unclear.

Methods

An L5S1 disc disease was operated by endoscopic method. Difficulty in separating the dural sac from PLL, dense adhesions prompting sharp dissection at this location and a calcified disc are the earliest evidence of intradural migration. MRI features of an intradural location are loss of continuity of posterior longitudinal ligament, beak-like appearance also known as “Hawk-beak sign”, peripheral enhancement around an intradural disc, fluid-filled intradural cyst. Magnification either by Microscope or Endoscope is of importance when dissecting the intradural disc so as to avoid the nerve root injury. Liberal use of fibrin glue and augmentation with muscle patch was performed.

Results

Ambulated by 48h and discharged by 5th day. Two and 9 months follow up showed no evidence of pseudomeningocoele.

Conclusion

Autologous muscle patch with fibrin glue for dural rent closure is a simple and effective method which can be performed by endoscopic or minimally invasive approaches. Suturing the dura, being a tedious and cumbersome procedure can be avoided.

Abstract

Purpose

Intradural migration of disc (IDMD) is a rare clinical entity accounting for 0.27–0.33% of all herniated disc diseases. Flimsy or dense adhesion between the ventral dural surface and the opposing posterior longitudinal ligament (PLL) is the principal pathology for intradural migrated disc. The most commonly affected lumbar segments are L4-5 (55%), L3-4 (16%), L5-S1 (10%) and less commonly L2L3 and L1L2. No imaging feature is characteristic and the management protocol of durotomy via an endoscopic method is unclear.

Methods

An L5S1 disc disease was operated by endoscopic method. Difficulty in separating the dural sac from PLL, dense adhesions prompting sharp dissection at this location and a calcified disc are the earliest evidence of intradural migration. MRI features of an intradural location are loss of continuity of posterior longitudinal ligament, beak-like appearance also known as “Hawk-beak sign”, peripheral enhancement around an intradural disc, fluid-filled intradural cyst. Magnification either by Microscope or Endoscope is of importance when dissecting the intradural disc so as to avoid the nerve root injury. Liberal use of fibrin glue and augmentation with muscle patch was performed.

Results

Ambulated by 48h and discharged by 5th day. Two and 9 months follow up showed no evidence of pseudomeningocoele.

Conclusion

Autologous muscle patch with fibrin glue for dural rent closure is a simple and effective method which can be performed by endoscopic or minimally invasive approaches. Suturing the dura, being a tedious and cumbersome procedure can be avoided.

Get Citation

Keywords

Intradural migrated disc disease, Endoscopic management, Muscle patch, Fibrin glue

About this article
Title

Transdural herniated lumbar disc disease with muscle patch for closure of durotomy – A Brief review of literature

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 51, No 2 (2017)

Pages

149-155

DOI

10.1016/j.pjnns.2016.12.002

Bibliographic record

Neurol Neurochir Pol 2017;51(2):149-155.

Keywords

Intradural migrated disc disease
Endoscopic management
Muscle patch
Fibrin glue

Authors

Harsha A. Huliyappa
Rakesh Kumar Singh
Sunil Kumar Singh
Manish Jaiswal
Somil Jaiswal
Chhitij Srivastava
Balkrishna Ojha
Anil Chandra
Satnam Chhabra

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