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Background: Although incidental dural tears are relatively common during spine surgery, transdural nerve root herniation without the identification of dural tear is a rare complication during spine surgery.Case presentationAn 80-year-old woman was diagnosed with L4-5 degenerative spondylolisthesis with spinal stenosis. The patient underwent L4-5 posterior decompression surgery and without any obvious incidental dural tear during surgery. On postoperative day (POD) 2, she complained of left leg pain. Magnetic resonance imaging (MRI) on POD 3 did not show any clearly causative lesion. Her left leg pain remained, but she was ambulatory. MRI findings on POD 15 were suggestive of transdural nerve root herniation contained in a pseudomeningocele. Reoperation was performed on the same day. Herniated cauda equina fibers were observed through a dural tear and dural closure was performed with continuous suturing after reduction of the herniated cauda equina fibers. Her left leg pain resolved immediately after surgery. At 12 months after surgery she reported that she had been doing housework without pain or bladder problems. Conclusion: Reoperation was performed for transdural nerve root herniation after lumbar decompression surgery, and resulted in a favorable outcome. Clinicians should be aware that transdural nerve root herniation can occur, even if no dural tear is identified intraoperatively.

Introduction: Primary epidural extra-osseous Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) is a rare entity included in the Ewing sarcoma family of tumors (ESFTs) that is associated with an unfavorable prognosis. Methods: We described the case of a patient with primary epidural extra-osseous ES/pPNET of the cervical spine, and reviewed the relevant literature for reports on this rare malignant tumor. Our research yielded 24 articles describing 40 patients. We analyzed these reports to identify factors associated with long-term survival. Results: A 30-year-old woman presented with pain and numbness in the right scapula and right upper limb. Cervical MRI showed an epidural mass extending into the right C6-7 foramina. We performed gross total resection of the mass; the histological diagnosis was ES/pPNET. We also performed adjuvant chemoradiotherapy after the operation. No recurrence has been observed for 10 years. Based on the review of the literature, we conducted a Kaplan-Meier analysis of 36 patients who underwent surgery. The analysis showed that the median survival time in patients treated with adjuvant chemotherapy was significantly longer than that in patients treated without adjuvant chemotherapy (25 months vs. 18 months, p = 0.002, log-rank test), whereas neither the mode of resection nor the performance of adjuvant radiotherapy significantly influenced survival. Conclusions: Long-term survival (>10 years) was obtained by gross total resection and adjuvant chemoradiotherapy. Adjuvant chemotherapy was associated with a long median survival time in a patient with epidural extra-osseous ES/pPNET of the cervical spine.