Revisión sistemática de la hernia discal intradural: perspectiva de un neurocirujano

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia Pub Date : 2026-05-01 Epub Date: 2026-02-17 DOI:10.1016/j.neucir.2025.500743

Alberto Morello, Enrico Lo Bue, Ayoub Saaid, Stefano Colonna, Alessandro Pesaresi, Federica Bellino, Marco Ajello, Alessandro Fiumefreddo, Diego Garbossa, Fabio Cofano

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引用次数: 0

Abstract

Intradural disk herniation (IDH) refers to the protrusion of the nucleus pulposus into the dural sac. While disk herniation is a relatively frequent condition, the intradural variant is exceptionally rare. Patients diagnosed with IDH often exhibit more pronounced clinical symptoms compared to those with extradural herniations. Establishing a definitive preoperative diagnosis remains challenging, as the pathophysiology and radiological features are not yet fully understood. Differentiating IDH from other intradural extramedullary pathologies, including schwannomas, neurofibromas, meningiomas, or metastatic lesions, can be complex.

A systematic review was conducted on the diagnosis and treatment of cervical, thoracic and lumbar IDH, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and retrieving potentially relevant literature from PubMed and Embase. The search strategy included combinations of the terms “transdural” OR “intradural” AND “disc” AND “herniation”. Age, sex, symptoms, herniated disk level, history of trauma, location of disk mass, imaging examination, pre- or intraoperative diagnosis and clinical outcomes were studied through the medical records. The type of surgery, the ventral dural defect management and the postoperative leakage of cerebrospinal fluid were also evaluated.

One hundred and sixty-one articles involving 285 patients were selected. Cases of IDHs occurred at the lumbar (64.3%), thoracic (21.9%) and cervical (13.8%) levels. The most common level IDH was located at L4–L5 (27.6%). 49 patients exhibited cauda equina syndrome. Only 44 patients (15.4%) were diagnosed as having IDH preoperatively, while most patients were diagnosed intraoperatively. Neurological functions improved variably according to cervical, thoracic and lumbar locations (respectively 2.5%, 5.6% and 21.7%).

IDH mostly involves the lumbar spine. Patients with IDH generally experience more severe symptoms than those with extradural disk herniation and have incomplete recovery of postoperative neurological functions. Diagnosing IDH remains challenging given its clinical presentations and radiographic features, and it is likely an underdiagnosed and underestimated condition.

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硬膜内椎间盘突出的系统回顾：神经外科医生的观点

硬膜内椎间盘突出（IDH）是指髓核突出到硬膜囊。虽然椎间盘突出是一种比较常见的情况，但硬膜内的变型非常罕见。与硬膜外疝相比，诊断为IDH的患者通常表现出更明显的临床症状。建立明确的术前诊断仍然具有挑战性，因为病理生理学和放射学特征尚未完全了解。将IDH与其他硬膜内髓外病变（包括神经鞘瘤、神经纤维瘤、脑膜瘤或转移性病变）鉴别是很复杂的。遵循PRISMA指南（系统评价和荟萃分析的首选报告项目），并从PubMed和Embase检索可能相关的文献，对颈、胸、腰椎IDH的诊断和治疗进行了系统评价。搜索策略包括术语“硬膜外”或“硬膜内”、“椎间盘”和“疝出”的组合。通过病历研究患者的年龄、性别、症状、椎间盘突出程度、外伤史、椎间盘肿块位置、影像学检查、术前或术中诊断及临床结果。并对手术方式、腹侧硬脑膜缺损处理及术后脑脊液漏进行了评价。共选取161篇文章，涉及285例患者。IDHs病例发生在腰椎（64.3%）、胸椎（21.9%）和颈椎（13.8%）。最常见的IDH水平位于L4-L5（27.6%）。49例出现马尾综合征。只有44例（15.4%）患者术前诊断为IDH，而大多数患者是术中诊断的。神经功能根据颈椎、胸椎和腰椎部位的不同有不同程度的改善（分别为2.5%、5.6%和21.7%）。IDH主要累及腰椎。IDH患者通常比硬膜外椎间盘突出患者症状更严重，术后神经功能恢复不完全。鉴于其临床表现和影像学特征，IDH的诊断仍然具有挑战性，并且很可能是一种未被诊断和低估的疾病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurocirugia 医学-神经科学

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

60 days

期刊介绍： Neurocirugía is the official Journal of the Spanish Society of Neurosurgery (SENEC). It is published every 2 months (6 issues per year). Neurocirugía will consider for publication, original clinical and experimental scientific works associated with neurosurgery and other related neurological sciences. All manuscripts are submitted for review by experts in the field (peer review) and are carried out anonymously (double blind). The Journal accepts works written in Spanish or English.