Transdural Nerve Rootlet Entrapment in the Intervertebral Disc Space through Minimal Dural Tear : Report of 4 Cases
A 66-year-old male presented with a 1-month history of back pain and left leg pain. Initial MRI showed disc bulging at L2-3 and L3-4 and foraminal stenosis at L4-5 bilaterally (). He underwent bilateral HLD at L2-3 and L3-4, together with the insertion of a DIAM (Medtronic, Inc., TN, USA). After brief improvement, he experienced a severe recurrence of symptoms. Over a 5-month period, he underwent HLD, percutaneous endoscopic lumbar discectomy (PELD), and unilateral transforaminal lumbar interbody fusion (TLIF) at L4-5 on the left side. However, the left leg pain persisted. Repeat MRI showed rootlet entrapment in the L2-3 disc space (). Magnetic resonance myelography showed continuity of the CSF within the disc space (). We suspected that the severe recurring leg pain was caused by rootlet entrapment that had developed after the first operation. We performed unilateral TLIF at L2-3. There was a ventral dural defect, which was not observed during the first operation, and rootlet entrapment in the intervertebral disc space. We repositioned the entrapped rootlet and closed of the dural defect. During the operation, we noted that the L2-3 disc space was filled with CSF. The patient's symptoms improved and finally disappeared after 6 months.