Transdural Nerve Rootlet Entrapment in the Intervertebral Disc Space through Minimal Dural Tear : Report of 4 Cases
A 52-year-old female presented with a 2-month history of low back pain and right leg pain. Preoperative magnetic resonance imaging (MRI) showed disc herniation at L4-5 on the right side (). The patient underwent hemilaminectomy and discectomy (HLD) at L4-5 on the right side. During the operation, we noted that the ventral dura was severely adhered to the surrounding tissue. During dissection, the thinned dura was minimally torn. We applied the TachoComb® at the dural tear site. There was no cerebrospinal fluid (CSF) leakage or rootlet herniation noted. The patient's symptoms initially improved considerably. Postoperative MRI showed good decompression (). However, after postoperative day 15, she developed extremely severe recurring radiating pain in the right leg. Repeat MRI showed that a rootlet was entrapped into the L4-5 disc space (). A transdural repair was adopted. We found a rootlet entrapment through a widened ventral dural defect. The herniated rootlet was adhered to the surrounding tissue. Meticulous dissection was performed and we repositioned the entrapped rootlet and performed duroplasty. The patient's symptoms improved postoperatively and finally disappeared after 6 months.