Intradural disc herniation

Intradural disc herniations (IDH) occur when disc material related to an intervertebral disc hernia penetrate the spinal dura and lies in an intradural extramedullary location.

IDH correspond to a rare presentation of a common pathology, comprising ~0.28% of all disc herniations 2

Symptoms are indistinguishable from the other disc hernias. A higher incidence of cauda equina syndrome has been reported when compared to extradural hernias 2

Intradural disc herniations represent a challenge for pre-operative diagnosis, with most of the cases only confirmed in the surgery. 

Although CT has a known limitation to assess the dural sac and spinal cord, when air is present in the degenerated intervertebral disc space (vacuum phenomenon), this can migrate to the herniated mass and delineates the intradural component of a hernia 3.

The intradural herniated disc may be delineated protruding into the dural sac. However, it can be difficult to differentiate from an intradural tumour. Post-contrast images will delineate an incomplete ring enhancement (chronic granulation tissue
and peripheral neovascularization), helping in distinguishing it from those tumours 3.

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rID: 43529
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