Intradural sequestration of a L3-L4 herniated intervertebral disc. Case report and literature review

The issues of etiology, pathogenesis, diagnosis and surgical treatment of intradural sequestration of herniated intervertebral discs are poorly reviewed in the world literature. This pathology occurs in 0.26–0.30 % of cases of all intervertebral disc herniations. The basis of pathogenesis is scar-adhesive changes in the spinal canal, leading to dense fusion of the dura mater with the posterior longitudinal ligament and collapse of the ventral epidural space. The main clinical manifestations are long-term pain in the lumbar spine with possible radicular symptoms. There was also a high incidence of acute caudal radicular ischemia (29 % of cases). An important factor in the differential diagnosis of intradural sequestration of intervertebral discs and intradural extramedullar neoplasms are neuroimaging phenomena (hawk-beak sign, Y-sign, ring enhancement) observed on magnetic resonance imaging in the native mode and with intravenous contrast enhancement. The correct preoperative diagnosis and, as a result, competent planning of surgical intervention are the keys to a favorable clinical outcome in this group of patients. The article describes a clinical case of 55-year-old patient treatment who underwent surgery in 2023 to remove an intradural sequestration of a herniated intervertebral disc at the L3–L4 level. An overview of the world literature is also presented, and the features of this pathology important for medical practice are discussed. © 2025 Elsevier B.V., All rights reserved.