title: Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report.
abstract: A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD.
authors.affiliation: Department of Orthopedics, Tokushima Municipal Hospital; and.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tamaki
authors.affiliation: Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Miyagi
authors.affiliation: Department of Orthopedics, Tokushima Municipal Hospital; and.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Orthopedics, Tokushima Municipal Hospital; and.
authors.forename: Tateaki
authors.initials: T
authors.lastname: Shimakawa
authors.affiliation: Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sairyo
authors.affiliation: Department of Orthopedics, Tokushima Municipal Hospital; and.
authors.forename: Takashi
authors.initials: T
authors.lastname: Chikawa
mesh_terms: D017587:Diskectomy, Percutaneous / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000209:etiology*; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016896:Treatment Outcome
keywords: LBP = low-back pain; LDH = lumbar disc herniation; PELD = percutaneous endoscopic lumbar discectomy; PLL = posterior longitudinal ligament; complications; intradural disc herniation; low-back pain; percutaneous endoscopic lumbar discectomy