title: Transdural herniated lumbar disc disease with muscle patch for closure of durotomy - A Brief review of literature.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India. Electronic address: harsha_huliyappa@yahoo.com.
authors.forename: Harsha A
authors.initials: HA
authors.lastname: Huliyappa
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India.
authors.forename: Rakesh Kumar
authors.initials: RK
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Jaiswal
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India.
authors.forename: Somil
authors.initials: S
authors.lastname: Jaiswal
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India.
authors.forename: Chhitij
authors.initials: C
authors.lastname: Srivastava
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India.
authors.forename: Balkrishna
authors.initials: B
authors.lastname: Ojha
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, UP, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Chandra
authors.affiliation: Department of Neurosurgery, Sri Gangaram Hospital, New Delhi, India.
authors.forename: Satnam
authors.initials: S
authors.lastname: Chhabra
mesh_terms: D000328:Adult; D002483:Cellulose, Oxidized / Q000008:administration & dosage; D017586:Diskectomy / Q000379:methods*; D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000637:transplantation
chemical_list: D002483:Cellulose, Oxidized; C013695:Surgicel
keywords: Endoscopic management; Fibrin glue; Intradural migrated disc disease; Muscle patch