Acta Rheumatologica

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Thoracic Intradural Disc Herniation: Key Considerations in Operative Management

Charlotte Katharine Gunner James Tomlinson Anna Lillian Watts Antony Rex Michael

Purpose: A case presentation of intradural T11/12 disc with particular reference to the operative management, to emphasise the importance of identifying these rare cases and identify important operative considerations.

Method: An 80 year old gentleman presented clinic with acute onset back and leg pain. He described pain in the L4 dermatomal distribution to both legs, with normal bladder and bowel function. Lower limb power was normal, L3/4 reflexes were reduced and there were no signs of cord compression. MRI was performed which demonstrated a T11/12 disc prolapse with a possible intradural element.

Results: The patient underwent elective T11/12 discectomy. Neurosurgical assistance was requested due to suspicion of an intradural disc. On entering the spinal canal there was only a small amount of disc material found which was removed. Pedicle subtraction was performed to allow access anterolaterally but no disc fragment was found. Durotomy was performed and a large soft tissue mass was found intradurally with extensive adhesions to both dura and spinal cord. This was carefully dissected free and removed. Samples were sent for intra-operative frozen section. This confirmed degenerative disc only.

Conclusions: Clinical findings may not correlate with MRI findings in these rare cases due to the intradural nature of the disc material. Intradural discs are extremely rare, especially in the thoracic region. Cases should be undertaken jointly with neurosurgical colleagues in case durotomy is needed. Intraoperative frozen section should be strongly considered as the clinical appearance may strongly mimic that of neoplastic disease.