Intradural disc herniations occur when disc material related to an intervertebral disc hernia penetrates the spinal dura and lies in an intradural extramedullary location.
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Epidemiology
Intradural disc herniations correspond to a rare presentation of a common pathology, comprising ~0.28% of all disc herniations 2.
Clinical presentation
Symptoms are indistinguishable from other types of disc hernias. A higher incidence of cauda equina syndrome has been reported when compared to extradural hernias 2.
Radiographic features
Intradural disc herniations represent a challenge for preoperative diagnosis, with most of the cases only confirmed at surgery.
CT
Although CT has a known limitation to assess the dural sac and spinal cord, when gas is present in the degenerated intervertebral disc space (vacuum phenomenon), this can migrate to the herniated mass and delineate the intradural component of a hernia 3.
MRI
The intradural herniated disc may be delineated protruding into the dural sac. However, it can be difficult to differentiate from an intradural tumor, particularly if the disc material has migrated away from the donor disc.
Postcontrast images will delineate an incomplete ring enhancement (chronic granulation tissue and peripheral neovascularization), helping to distinguish it from tumors 3.
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