Transdural Nerve Rootlet Entrapment in the Intervertebral Disc Space through Minimal Dural Tear : Report of 4 Cases
A 59-year-old female presented with a 1-month history of back pain and bilateral leg pain, more severe on the left. Preoperative MRI showed disc herniation at L1-2, ossification of the posterior longitudinal ligament (OPLL), central spinal stenosis at L1-2, and fusion of L2-3-4-5 with pedicle screws (). We performed anterior lumbar interbody fusion (ALIF), lateral screw insertion, and OPLL removal at L1-2. During ALIF, the ventral dura was torn and this dural defect was compactly sealed with TachoComb® and fibrin glue. This treatment stopped the CSF leakage, and the patient's symptoms improved postoperatively. However, after 2 months, she complained of severe recurring pain in both legs. Repeat MRI showed rootlet entrapment through the ventral dural defect site at L1-2 (). We repositioned the entrapped rootlet and performed duroplasty. Her symptoms improved and finally disappeared after 6 months.