{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T03:10:05Z","timestamp":1770520205080,"version":"3.49.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,18]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Incidental dural tears are a well-known but potentially serious complication of spinal surgery. The authors present a unique case of delayed cauda equina herniation through an occult dural tear without any evident CSF leakage, emphasizing diagnostic challenges and preventive measures specific to unilateral biportal endoscopy (UBE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 60-year-old man underwent UBE decompression for lumbar canal stenosis and experienced immediate symptom relief. However, 3 weeks postoperatively, he developed acute severe radicular pain, initially presumed to be caused by disc herniation. Despite repeated decompression, his symptoms progressively worsened. MRI findings remained nonspecific, without CSF leakage. Exploratory surgery ultimately revealed herniation of the cauda equina through an occult dural tear. Surgical repair led to rapid symptom relief and complete recovery without neurological deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights the importance of considering dural pathology as a potential cause of intractable postoperative radicular pain, even when perioperative findings are inconclusive. Continuous irrigation can compress the dura, mask small dural tears, or tamponade minor leaks, delaying recognition. Surgeons should be aware that UBE\u2019s technical environment carries a risk of undetected dural injuries. Prompt recognition and repair of dural defects are essential to prevent rare but serious complications like cauda equina herniation.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25438\">https:\/\/thejns.org\/doi\/10.3171\/CASE25438<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25438","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T23:48:22Z","timestamp":1756770502000},"source":"Crossref","is-referenced-by-count":2,"title":["Delayed herniation of cauda equina root through occult dural tear following unilateral biportal endoscopic decompression: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Keitaro","family":"Matsukawa","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6278-3934","authenticated-orcid":true,"given":"Kanehiro","family":"Fujiyoshi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiomi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Kitagawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiyuki","family":"Yato","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"22","key":"bib1","series-title":"Spine (Phila Pa 1976)","first-page":"E1339","article-title":"Incidental durotomy during spinal surgery: a multivariate analysis for risk factors","volume":"39","author":"Du","year":"2014","unstructured":"Du JYAichmair AKueper JIncidental durotomy during spinal surgery: a multivariate analysis for risk factors. Spine (Phila Pa 1976). 2014;39(22):E1339-E1345."},{"issue":"4","key":"bib2","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature","volume":"39","author":"Ghobrial","year":"2015","unstructured":"Ghobrial GMTheofanis TDarden BVArnold PFehlings MGHarrop JS.Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature. Neurosurg Focus. 2015;39(4):E8."},{"issue":"9","key":"bib3","series-title":"Eur Spine J","first-page":"2069","article-title":"Incidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery","volume":"24","author":"Khazim","year":"2015","unstructured":"Khazim RDannawi ZSpacey KIncidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery. Eur Spine J. 2015;24(9):2069-2076."},{"issue":"23","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"2576","article-title":"Herniation and entrapment of a nerve root secondary to an unrepaired small dural laceration at lumbar hemilaminectomies","volume":"20","author":"Nishi","year":"1995","unstructured":"Nishi SHashimoto NTakagi YTsukahara T.Herniation and entrapment of a nerve root secondary to an unrepaired small dural laceration at lumbar hemilaminectomies. Spine (Phila Pa 1976). 1995;20(23):2576-2579."},{"issue":"13","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"1501","article-title":"Pseudomeningocele nerve root entrapment after lumbar discectomy","volume":"23","author":"O\u2019Connor","year":"1998","unstructured":"O\u2019Connor DMaskery NGriffiths WE.Pseudomeningocele nerve root entrapment after lumbar discectomy. Spine (Phila Pa 1976). 1998;23(13):1501-1502."},{"issue":"6","key":"bib6","series-title":"Asian Spine J","first-page":"790","article-title":"Risk factors and options of management for an incidental dural tear in biportal endoscopic spine surgery","volume":"14","author":"Kim","year":"2020","unstructured":"Kim JEChoi DJPark EJ.Risk factors and options of management for an incidental dural tear in biportal endoscopic spine surgery. Asian Spine J. 2020;14(6):790-800."},{"issue":"4","key":"bib7","series-title":"J Spinal Cord Med","first-page":"552","article-title":"Nerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: a case report","volume":"43","author":"Shu","year":"2020","unstructured":"Shu WWang HZhu HNerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: a case report. J Spinal Cord Med. 2020;43(4):552-555."},{"issue":"6","key":"bib8","series-title":"Glob Spine J","first-page":"845","article-title":"Dural injury in unilateral biportal endoscopic spine surgery","volume":"11","author":"Lee","year":"2021","unstructured":"Lee HGKang MSKim SYDural injury in unilateral biportal endoscopic spine surgery. Glob Spine J. 2021;11(6):845-851."},{"issue":"1","key":"bib9","series-title":"Acta Neurochir (Wien)","first-page":"95","article-title":"Unintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors","volume":"166","author":"Yu","year":"2024","unstructured":"Yu HZhao QLv JUnintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors. Acta Neurochir (Wien). 2024;166(1):95."},{"key":"bib10","series-title":"Front Surg","first-page":"1487567","article-title":"Dural tears with cauda equina herniation following percutaneous endoscopic lumbar discectomy: a case report and literature review","volume":"11","author":"Xie","year":"2024","unstructured":"Xie SLuo MXiao H.Dural tears with cauda equina herniation following percutaneous endoscopic lumbar discectomy: a case report and literature review. Front Surg. 2024;11:1487567."},{"issue":"12","key":"bib11","series-title":"J Int Med Res","first-page":"3000605221144147","article-title":"Treatment of dural tear with nerve root herniation after unilateral biportal endoscopic decompression using an epidural blood patch:a case report","volume":"50","author":"Chun","year":"2022","unstructured":"Chun YMLee SHMoon KSChang MC.Treatment of dural tear with nerve root herniation after unilateral biportal endoscopic decompression using an epidural blood patch:a case report. J Int Med Res. 2022;50(12):3000605221144147."},{"issue":"3","key":"bib12","series-title":"Korean J Spine","first-page":"103","article-title":"Incarceration of spinal nerve root through incidental durotomy as a cause of sciatica","volume":"14","author":"Kim","year":"2017","unstructured":"Kim YJ.Incarceration of spinal nerve root through incidental durotomy as a cause of sciatica. Korean J Spine. 2017;14(3):103-105."},{"issue":"20","key":"bib13","series-title":"Spine (Phila Pa 1976)","first-page":"2663","article-title":"Incidental durotomy in spine surgery","volume":"25","author":"Cammisa","year":"2000","unstructured":"Cammisa FPJrGirardi FPSangani PKParvataneni HKCadag SSandhu HS.Incidental durotomy in spine surgery. Spine (Phila Pa 1976). 2000;25(20):2663-2667."},{"issue":"389","key":"bib14","series-title":"Clin Orthop Relat Res","first-page":"238","article-title":"Evaluation and treatment of dural tears in lumbar spine surgery: a review","author":"Bosacco","year":"2001","unstructured":"Bosacco SJGardner MJGuille JT.Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001;(389):238-247."},{"issue":"22","key":"bib1","series-title":"Spine (Phila Pa 1976)","first-page":"E1339","article-title":"Incidental durotomy during spinal surgery: a multivariate analysis for risk factors","volume":"39","author":"Du","year":"2014","unstructured":"Du JYAichmair AKueper JIncidental durotomy during spinal surgery: a multivariate analysis for risk factors. Spine (Phila Pa 1976). 2014;39(22):E1339-E1345."},{"issue":"4","key":"bib2","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature","volume":"39","author":"Ghobrial","year":"2015","unstructured":"Ghobrial GMTheofanis TDarden BVArnold PFehlings MGHarrop JS.Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature. Neurosurg Focus. 2015;39(4):E8."},{"issue":"9","key":"bib3","series-title":"Eur Spine J","first-page":"2069","article-title":"Incidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery","volume":"24","author":"Khazim","year":"2015","unstructured":"Khazim RDannawi ZSpacey KIncidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery. Eur Spine J. 2015;24(9):2069-2076."},{"issue":"23","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"2576","article-title":"Herniation and entrapment of a nerve root secondary to an unrepaired small dural laceration at lumbar hemilaminectomies","volume":"20","author":"Nishi","year":"1995","unstructured":"Nishi SHashimoto NTakagi YTsukahara T.Herniation and entrapment of a nerve root secondary to an unrepaired small dural laceration at lumbar hemilaminectomies. Spine (Phila Pa 1976). 1995;20(23):2576-2579."},{"issue":"13","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"1501","article-title":"Pseudomeningocele nerve root entrapment after lumbar discectomy","volume":"23","author":"O\u2019Connor","year":"1998","unstructured":"O\u2019Connor DMaskery NGriffiths WE.Pseudomeningocele nerve root entrapment after lumbar discectomy. Spine (Phila Pa 1976). 1998;23(13):1501-1502."},{"issue":"6","key":"bib6","series-title":"Asian Spine J","first-page":"790","article-title":"Risk factors and options of management for an incidental dural tear in biportal endoscopic spine surgery","volume":"14","author":"Kim","year":"2020","unstructured":"Kim JEChoi DJPark EJ.Risk factors and options of management for an incidental dural tear in biportal endoscopic spine surgery. Asian Spine J. 2020;14(6):790-800."},{"issue":"4","key":"bib7","series-title":"J Spinal Cord Med","first-page":"552","article-title":"Nerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: a case report","volume":"43","author":"Shu","year":"2020","unstructured":"Shu WWang HZhu HNerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: a case report. J Spinal Cord Med. 2020;43(4):552-555."},{"issue":"6","key":"bib8","series-title":"Glob Spine J","first-page":"845","article-title":"Dural injury in unilateral biportal endoscopic spine surgery","volume":"11","author":"Lee","year":"2021","unstructured":"Lee HGKang MSKim SYDural injury in unilateral biportal endoscopic spine surgery. Glob Spine J. 2021;11(6):845-851."},{"issue":"1","key":"bib9","series-title":"Acta Neurochir (Wien)","first-page":"95","article-title":"Unintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors","volume":"166","author":"Yu","year":"2024","unstructured":"Yu HZhao QLv JUnintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors. Acta Neurochir (Wien). 2024;166(1):95."},{"key":"bib10","series-title":"Front Surg","first-page":"1487567","article-title":"Dural tears with cauda equina herniation following percutaneous endoscopic lumbar discectomy: a case report and literature review","volume":"11","author":"Xie","year":"2024","unstructured":"Xie SLuo MXiao H.Dural tears with cauda equina herniation following percutaneous endoscopic lumbar discectomy: a case report and literature review. Front Surg. 2024;11:1487567."},{"issue":"12","key":"bib11","series-title":"J Int Med Res","first-page":"3000605221144147","article-title":"Treatment of dural tear with nerve root herniation after unilateral biportal endoscopic decompression using an epidural blood patch:a case report","volume":"50","author":"Chun","year":"2022","unstructured":"Chun YMLee SHMoon KSChang MC.Treatment of dural tear with nerve root herniation after unilateral biportal endoscopic decompression using an epidural blood patch:a case report. J Int Med Res. 2022;50(12):3000605221144147."},{"issue":"3","key":"bib12","series-title":"Korean J Spine","first-page":"103","article-title":"Incarceration of spinal nerve root through incidental durotomy as a cause of sciatica","volume":"14","author":"Kim","year":"2017","unstructured":"Kim YJ.Incarceration of spinal nerve root through incidental durotomy as a cause of sciatica. Korean J Spine. 2017;14(3):103-105."},{"issue":"20","key":"bib13","series-title":"Spine (Phila Pa 1976)","first-page":"2663","article-title":"Incidental durotomy in spine surgery","volume":"25","author":"Cammisa","year":"2000","unstructured":"Cammisa FPJrGirardi FPSangani PKParvataneni HKCadag SSandhu HS.Incidental durotomy in spine surgery. Spine (Phila Pa 1976). 2000;25(20):2663-2667."},{"issue":"389","key":"bib14","series-title":"Clin Orthop Relat Res","first-page":"238","article-title":"Evaluation and treatment of dural tears in lumbar spine surgery: a review","author":"Bosacco","year":"2001","unstructured":"Bosacco SJGardner MJGuille JT.Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001;(389):238-247."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25438.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25438.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25438.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:10:16Z","timestamp":1769685016000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/7\/article-CASE25438.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":28,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.3171\/case25438","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]}}}