Simultaneous two-level intradural disc herniation mimicking intradural tumors: illustrative case.

backgroundIntradural disc herniation (IDDH) is a rare variant of lumbar disc herniation, accounting for less than 0.3% of cases. The occurrence of multiple IDDHs at different spinal levels in a patient with no history of spinal surgery is uncommon. This report presents a case of multilocular intradural lumbar disc herniation to highlight diagnostic and management challenges posed by pathology. OBSERVATIONS: A 50-year-old male with no prior spinal surgery presented with progressive neurological deficits. MRI revealed two intradural extramedullary masses at the L4-5 and S2 levels, leading to an initial diagnosis of intradural tumors. The patient underwent microsurgical resection of the L4-5 lesion. Intraoperatively, the mass resembled atypical meningioma, but histopathological analysis confirmed a herniated disc fragment. A follow-up MRI study 3 months later showed spontaneous resorption of the S2 lesion, another rare phenomenon. LESSONS: This case demonstrates that IDDH can present as multiple, noncontiguous lesions and occur in patients without a history of spinal surgery. It is crucial to consider IDDH in the differential diagnosis of multiple intradural spinal tumors, especially with a history of lumbar disc herniation. Furthermore, this case provides evidence for the phenomenon of spontaneous resorption of intradural disc fragments, which can influence patient management. https://thejns.org/doi/10.3171/CASE26158.