Intradural disc herniation associated with epidural gas

Study Design. A case report of a patient suffering from an intradural herniated disc associated with the presence of epidural gas. Objective. To advise spine surgeons of the possible association of intradural disc herniation and epidural gas, to prevent overlooking intradural disc fragments during surgery. Summary of Background Data. Three cases of this rare association were published previously, something surprising given the relatively rare occurrence of intradural herniations and the presence of epidural gas. Methods. A case is presented where such an association occurred, on the basis of preoperative examinations and intraoperative findings. The literature is reviewed for cases of herniated discs associated with epidural gas and for intradural herniations. Results. During the open discectomy, after a negative epidural examination, an intradural examination was performed, revealing a disc herniation, which was removed. The patient's postoperative development was satisfactory. Conclusion. The possibility of an intradural herniated disc must always be considered when performing an open discectomy on a patient whose computed tomography scan reveals the presence of epidural gas. In the event that no clear disc herniation is found to justify the clinical symptoms or the previous radiologic findings, an intradural exploration may be indicated.