Dorsal Epidural Intervertebral Disk Herniation With Atypical Radiographic Findings: Case Report and Literature Review

Teufack, Sonia; Singh, Harminder; Ratliff, John K.

doi:10.1080/10790268.2010.11689706

Cited by 34 publications

(31 citation statements)

References 14 publications

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“…Twenty-seven studies containing 41 cases were included in the systematic review in addition to the 6 new cases reported here. 3,[5][6][7][9][10][11][12]14,[16][17][18][19][20][21][22][23][24]29,33,34,[38][39][40][41][42]44 We reviewed and analyzed all available data, including clinical presentation, imaging findings, therapeutic interventions, and outcome.…”

Section: Systematic Review Of the Literaturementioning

confidence: 99%

Posterior epidural migration of a lumbar disc fragment: a series of 6 cases

Akhaddar¹,

Elasri²,

Boucetta³

2011

SPI

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Object The migration of a lumbar intervertebral disc fragment to the posterior epidural space is a rare complication of lumbar disc herniation (LDH), mostly diagnosed intraoperatively. The authors describe a series of 6 patients with a posterior epidural migration of a lumbar intervertebral disc fragment (PEMLIF) and provide a systematic review of the literature. Methods The authors undertook a retrospective case series of patients with PEMLIF who underwent surgery for LDH between February 2007 and June 2010. In 6 (1.04%) of 572 patients a diagnosis of PEMLIF was established. In addition, a systematic review of the literature produced 41 additional cases reported since 1973. The authors analyzed epidemiological, clinical, and imaging features, as well as surgical treatment and outcome of this infrequent form of LDH. Results This study represents the largest case series to analyze the distinguishing features of PEMLIF. Including the authors' cases, 37 male (78.72%) and 10 female (21.28%) patients (mean age 54.08 years) appear in the literature. Although the predominant clinical disturbance was related to cauda equina compression in 22 patients (46.80%), 19 patients (40.42%) presented with typical symptoms of sciatica or anterior thigh pain. In 27 patients (57.44%), PEMLIFs were localized at high lumbar levels. Magnetic resonance imaging was used in 36 cases. The PEMLIF appeared iso- to hypointense on T1-weighted imaging and had a variable intensity on T2-weighted imaging. After administration of Gd, 85.71% of lesions exhibited a peripheral ring. The preoperative diagnosis was never related to PEMLIF in 68% of cases. The PEMLIF was totally resected in all patients. An additional discectomy was performed in 31 patients (65.95%). Information was incomplete in 1 case. Of the remaining 46 patients, all improved postoperatively: total recovery was achieved in 33 cases (71.74%), subtotal recovery in 2 cases (4.35%), and improvement in 11 cases (23.91%). The postoperative outcome appeared not to depend on the duration or the degree of preoperative neurological deficits or the size of disc fragment. Conclusions The migration of a lumbar intervertebral disc fragment to the posterior epidural space is a rare event, occurring in an advanced working-age population. Clinical presentation is indistinguishable from the typical LDH, but overall cauda equina symptoms are far more common. High lumbar levels are more affected. Magnetic resonance imaging characteristics are difficult to differentiate from those of other entities. Ring enhancement after Gd administration is common. Outcomes in patients with cauda equina symptoms appear better than those in patients with standard ventral compression.

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Section: Systematic Review Of the Literaturementioning

confidence: 99%

Posterior epidural migration of a lumbar disc fragment: a series of 6 cases

Akhaddar¹,

Elasri²,

Boucetta³

2011

SPI

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“…As far as we know, our 9-case series of PEMSLIDF represents the largest to date. A detailed literature search yielded 60 cases with similar features since the original description of the condition (1,6,8-10, 12,14,15,17,19,20,22,[24][25][26][27][28][29][30][31][32][33][34]36,37,[41][42][43]45,[47][48][49][50][51][52][53][54]. This study aimed to assess the clinical and imaging properties of PEMSLIDF and to discuss its surgical treatment and postoperative outcomes.…”

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confidence: 99%

Posterior epidural migration of a sequestered lumbar Intervertebral disc fragment

Turan

Yılmaz²,

Göçmez³

et al. 2015

Turkish Neurosurgery

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“…22 This ring enhancement allows the differential diagnosis from other epidural lesions such as an epidural abscess, [25][26][27]31 primitive or metastatic epidural tumor, 10,14,18,27 synovial joint cyst, 6,27 some cartilaginous tumors such as chondrosarcoma, and epidural hematomas (Table 2). 25,27,28 No T1-wighted images with gadolinium were obtained before the operation in the current cases, and the posterior epidural masses were suspected to be a migrating disk hernia or a synovial cyst.…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Dorsal Epidural Migration of Lumbar Disk Fragments

Abe

Uchikado

Maruiwa³

et al. 2015

Neurosurgery Quarterly

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Herniated disk fragments are known to migrate in many directions within the spinal canal, but dorsal migration has been rarely reported. This report presents 2 cases of migration of the lumbar disk into the dorsal epidural space. A 65-year-old man complained of sciatica and numbness from the posterior surface of the bilateral thighs. Magnetic resonance imaging (MRI) showed a narrow spinal canal at L3-4. The mass was posterolateral in the epidural space at the L4 level. It was iso-hypointense on T1-weighted images and iso-hyperintense on T2-weigted images. A decompressive lumbar hemilaminectomy was performed. Surgery revealed the mass to be surrounded by a membranous thickened mass of the epidural venous plexus and was dorsal to the dural sac. The mass proved to be a migrated lumbar disk fragment. The patient made a good recovery after surgery. A 73-year-old man complained of lumbar pain and right leg pain in the L5 area. MRI showed a lumbar disk hernia at L4-5. The mass was posterolateral in the epidural space at L5. It was iso-hypointense on T1-weighted images and iso-hyperintense on T2-weigted images. Surgery revealed that the mass was surrounded by a fibrous membrane with epidural venous plexus and was dorsal to the dural sac. It was determined to be a migrated lumbar disk fragment. The patient made a good recovery after surgery. The preoperative diagnosis of a migrated lumbar disk hernia is difficult to make based only on the findings of nonenhanced MRI images, and thus it must be considered in the preoperative differential diagnosis.H erniated disk fragments can migrate in many directions within the spinal canal, but posterior epidural disk fragment migration has been rarely reported. The preoperative differential diagnosis of this condition is difficult. Moreover, the mechanism of posterior epidural disk fragment migration is unclear. This report describes 2 cases of posterior epidural disk fragment migration. CASE PRESENTATION Case 1A 65-year-old man complained of bilateral leg numbness and intermittent claudication. He had undergone cervical laminoplasty (C3-4) 1 year ago. His history showed lumbar canal stenosis at L4-5. His quadriparesis had improved gradually after cervical laminoplasty. The patient noted sciatica and numbness from the posterior surface of his bilateral thighs. Moreover, he had intermittent claudication and acute lumbago. He was given medication, but the symptoms did not improve sufficiently. A neurological examination found left toe and right leg weakness, and intermittent claudication. The pain thereafter gradually became worse when walking and with standing up retro-flexion. There were no bladder or bowel symptoms. Lumbar spine magnetic resonance imaging (MRI) revealed a mass in the dorsal epidural space at L3-4. The lesion was iso-hypointense on T1-weighted images, and iso-hyperintense on T2-weigted images (Fig. 1). MRI myelography revealed narrow canal stenosis and the mass was posterior to the dural sac. A left L3-4 hemilaminectomy was performed. The ligamentum flavum contained t...

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Dorsal Epidural Intervertebral Disk Herniation With Atypical Radiographic Findings: Case Report and Literature Review

Cited by 34 publications

References 14 publications

Posterior epidural migration of a lumbar disc fragment: a series of 6 cases

Posterior epidural migration of a lumbar disc fragment: a series of 6 cases

Posterior epidural migration of a sequestered lumbar Intervertebral disc fragment

Two Cases of Dorsal Epidural Migration of Lumbar Disk Fragments

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