J Korean Neurosurg Soc.  2013 Jan;53(1):52-56. 10.3340/jkns.2013.53.1.52.

Transdural Nerve Rootlet Entrapment in the Intervertebral Disc Space through Minimal Dural Tear : Report of 4 Cases

• Choi JH
• Kim JS
• Jang JS
• Lee DY

• KMID: 2066987
• DOI: http://doi.org/10.3340/jkns.2013.53.1.52

Abstract

Four patients underwent lumbar surgery. In all four patients, the dura was minimally torn during the operation. However, none exhibited signs of postoperative cerebrospinal fluid leakage. In each case, a few days after the operation, the patient suddenly experienced severe recurring pain in the leg. Repeat magnetic resonance imaging showed transdural nerve rootlets entrapped in the intervertebral disc space. On exploration, ventral dural tears and transdural nerve rootlet entrapment were confirmed. Midline durotomy, herniated rootlet repositioning, and ventral dural tear repair were performed, and patients' symptoms improved after rootlet repositioning. Even with minimal dural tearing, nerve rootlets may become entrapped, resulting in severe recurring symptoms. Therefore, the dural tear must be identified and repaired during the first operation.

Keyword

Nerve rootlet entrapment; Lumbar disc herniation; Laminectomy; Discectomy; Dura tear; Dura repair

MeSH Terms

Diskectomy
Humans
Intervertebral Disc
Laminectomy
Leg
Magnetic Resonance Imaging

Figure

• 

  Fig. 1 Before the operation : disc herniation at L4-5 on the right side (white arrow). A-1. Sagittal magnetic resonance image. B-1. Axial magnetic resonance image. After the operation : good decompression of L4-5. A-2. Sagittal magnetic resonance image. B-2. Axial magnetic resonance image. Rootlet herniation : rootlet herniating into the intervertebral disc space at L4-5 on the right side (black arrow). A-3. Sagittal magnetic resonance image. B-3. Axial magnetic resonance image.

• 

  Fig. 2 Before the operation : disc herniation at L2-3, L3-4, and L4-5. A-1. Sagittal magnetic resonance image. B-1. Axial magnetic resonance image showing disc herniation at L2-3 on the left side. Rootlet herniation : rootlet herniating into the intervertebral disc space at L2-3 on the left side (white arrow). A-2. Sagittal magnetic resonance image. B-2. Axial magnetic resonance image of L2-3. Myelogram : magnetic resonance myelogram showing intradiscal leakage of cerebrospinal fluid (white arrow).

• 

  Fig. 3 Initial magnetic resonance image : extraforaminal disc herniation at L4-5 on the left side. A-1. Sagittal magnetic resonance image. B-1. Axial magnetic resonance image of L4-5. Before the operation : paramedian disc herniation and extraforaminal disc herniation at L4-5 on the left side. A-2. Sagittal magnetic resonance image. B-2. Axial magnetic resonance image of L4-5. Rootlet herniation : rootlet herniating into the intervertebral disc space at L4-5 on the left side (white arrow). A-3. Sagittal magnetic resonance image. B-3. Axial magnetic resonance image of L4-5.

• 

  Fig. 4 Before the operation : disc herniation with osteophyte at L1-2 (white arrow). A-1. Sagittal magnetic resonance image. B-1. Axial magnetic resonance image of L1-2. Rootlet herniation : rootlet herniating into the intervertebral disc space at L1-2 (white arrow). After the operation : herniated rootlets were reposited.

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