Intradural disc herniation and epidural gas: something more than a casual association?
METHODS
The case of a patient with an intradural disc herniation associated with gas in the spinal canal is presented.


OBJECTIVE
To alert spine surgeons to this potential association.


BACKGROUND
This association was described previously in five patients, a fact that seems surprising given the relative rarity of both intraspinal gas and intradural herniations.


METHODS
The case is presented of a female patient with lumbosciatic pain who developed an incomplete cauda equina syndrome. An asymmetric discopathy of the L2-L3 space and a gas bubble with disc material within the spinal canal was noticed in the radiologic explorations. The literature and the authors' experience are reviewed with the aim of confirming the frequency of intradural herniation in association with gas in the spinal canal.


RESULTS
A laminoarthrectomy of the involved space was performed followed by direct intradural examination, which revealed a disc fragment that was excised. An instrumented L2-L3 arthrodesis was performed. Postoperative evolution was satisfactory. To date, the authors have found this association in 2% of the patients with intraspinal gas.


CONCLUSIONS
The potential presence of an intradural disc herniation must always be considered when performing an open discectomy on a patient whose CT scan study shows the presence of epidural gas. This association is particularly striking given the relative rarity of intradural herniations and intraspinal gas. In the event that no clear disc herniation was found, an intradural examination may be indicated to justify clinical signs and symptoms or previous radiologic studies.
Orthopaedic Surgery Department, Ubarmin Clinic and Virgen del Camino Hospital, Pamplona, Navarre, Spain. angelhidalgo@ya.com
Angel M
AM
Hidalgo-Ovejero
Serafin
S
García-Mata
Sonia
S
Gozzi-Vallejo
Tomás
T
Izco-Cabezón
Javier
J
Martínez-Morentín
Manuel
M
Martínez-Grande
D001863:Bone Screws; D002245:Carbon Dioxide / Q000009:adverse effects; D017586:Diskectomy; D004824:Epidural Space / Q000000981:diagnostic imaging; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D005740:Gases / Q000009:adverse effects; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007796:Laminectomy; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009408:Nerve Compression Syndromes / Q000209:etiology; D009584:Nitrogen / Q000009:adverse effects; D011128:Polyradiculopathy / Q000209:etiology; D011312:Pressure; D012021:Reflex, Abnormal; D012585:Sciatica / Q000209:etiology; D013123:Spinal Fusion; D013126:Spinal Nerve Roots; D014057:Tomography, X-Ray Computed
D005740:Gases; D002245:Carbon Dioxide; D009584:Nitrogen