Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration.
BACKGROUND
Intrathecal disc herniation is a rare but serious condition that has the potential to generate devastating neurologic deficits. We present a case of a 56-year-old man who developed cauda equina syndrome after several episodes of severe Valsalva maneuver.


METHODS
The patient was found to have developed subacute urinary retention and leg weakness. Magnetic resonance imaging findings were concerning for an unusual-appearing lesion extending cranially at L2-3. Urgent decompression via an L2 laminectomy, exploration, and subsequent discectomy was performed. The patient recovered exceptionally well, regaining bladder function and ultimately being able to ambulate without assistance.


CONCLUSIONS
Cranially extending intrathecal disc herniations are a rare phenomenon and exceptionally uncommon above L3. The clinician should have a high level of suspicion for herniation when looking at the clinical and historical information consistent with such a diagnosis even in the presence of ambiguous imaging findings.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: tempelzj@upmc.edu.
Zachary
Z
Tempel
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Xiao
X
Zhu
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Michael M
MM
McDowell
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Nitin
N
Agarwal
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Edward A
EA
Monaco
D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011128:Polyradiculopathy / Q000209:etiology*; D015898:Tomography Scanners, X-Ray Computed; D016055:Urinary Retention / Q000150:complications
Cauda equina; Disc herniation; Intradural; Intrathecal