Intradural disc herniation (IDDH) is a rare condition, accounting for less than 0.5% of herniated disc cases, primarily affecting the lumbar region and often presenting with severe nerve compression or cauda equina syndrome. This paper presents the case of a 60-year-old female with a history of hypertension, dyslipidemia, stroke, and hypothyroidism, who arrived with severe lower back pain, lower limb weakness, and urinary retention. MRI indicated a posterior dural-based mass with significant cauda equina compression and lumbar instability at L3-L4. During surgery, an IDDH was suspected due to adhesions, initially resembling a meningioma, and was confirmed histopathologically. Following excision and spinal fixation, the patient experienced substantial improvement in motor function and pain levels. This case underscores the need to consider IDDH in differential diagnoses for patients with severe neurological deficits, especially when imaging suggests neoplasms. Surgical intervention led to favorable outcomes, highlighting the importance of IDDH awareness and the need for further research into its pathogenesis and treatment guidelines.