PMC6834459_01
Lateral-plane roentgenogram showing severe degenerative changes.
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Plain radiography showed severe spondylotic changes (Fig. 1).
(A) T1 sagittal magnetic resonance image. (B) T2 sagittal magnetic resonance image showing occupation of the conus medullaris region with a mass continuous from discontinuity of the boundary line behind the L1/2 intervertebral disc and severe lower lumbar spinal canal stenosis. (C) Axial magnetic resonance image at L1/2 showing occupation of the mass from the left side to the dorsal side of the spinal canal. H, head; F, foot. (D) Coronal magnetic resonance image showing compression of the conus medullaris from the left side by the mass. The white arrows indicate the mass with low intensity on T1 imaging and isointensity to high intensity on T2 imaging.
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The mass showed low intensity on T1 imaging and isointensity to high intensity on T2 imaging (Fig. 2A-D).
(A) Sagittal computed tomography myelography image showing block of contrast medium and cup-like shape. (B) Coronal computed tomography myelography image showing block of contrast medium and cup-like shape. (C) Axial computed tomography myelography image showing a half ring-like shape. (D) Photograph of herniated fragments collected during surgery. The black arrow shows a fragment of the cartilage endplate. Other fragments were soft nucleus pulposus. Scale bar = 1 mm.
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Computed tomography myelography indicated that an intradural and extramedullary mass, continuous with the L1/2 disc, was compressing the CM (Fig. 3A-C). The cartilaginous endplate fragment, and other fragments of the nucleus pulposus within the nerve rootlet, were removed via a dura mater incision (Fig. 3D).
Postoperative magnetic resonance image shows disappearance of the intradural disc herniation compressing the conus medullaris at L1/2.
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A postoperative MRI indicated the IDH compressing the CM at L1/2 had disappeared (Fig. 4).