Dorsally Sequestered Cervical Disc Herniation

Tofuku, Katsuhiro; Koga, Hiroaki; Kawabata, Naoyuki; Yuasa, Shinya; Yone, Kazunori; Komiya, Setsuro

doi:10.1097/brs.0b013e31815ce6c4

Cited by 6 publications

(4 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4,25,28,29,31,36,43 Magnetic resonance imaging appears to be the method of choice for diagnosis. Generally, a posterior disc fragment demonstrated a heterogeneous low to isointense signal on T1-weighted imaging.…”

Section: Discussionmentioning

confidence: 99%

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

Akhaddar¹,

Elasri²,

Boucetta³

2011

SPI

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Akhaddar¹,

Elasri²,

Boucetta³

2011

SPI

View full text Add to dashboard Cite

show abstract

“…Originally in three more patients unusual sequestrated disc fragments were mistaken for another space occupying lesion and were operated. The biopsy revealed that they were disc material, thus accounting for total 10 cases reported in the entire literature by different authors [7,9,13]. The above data clearly indicate the extreme rarity of such non-traumatic extruded extradural disc in the cervical spine.…”

Section: Discussionmentioning

confidence: 74%

“…Few reports have suggested excision of the disc through posterior approach via laminectomy [6-9], while others opine that it can be excised by performing corpectomy [1] or microdiscectomy through adjacent disc space via anterior approach [10]. This varied opinion led us to retrospectively analyze our 396 cervical disc prolapse cases that we had treated over a period of 7 years.…”

Section: Introductionmentioning

confidence: 99%

Posterior Epidural Migration of Sequestrated Cervical Disc Fragment: Case Series

Srinivasan

Kumar²,

Mahesha

2011

Asian Spine J

View full text Add to dashboard Cite

Study DesignA retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse.PurposeTo present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management.Overview of LiteratureNon-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature.MethodsDetailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery.ResultsT1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated.ConclusionsWe opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome.

show abstract

“…Quoted as PEMLIFan acronym for posterior epidural migration of lumbar intervertebral disc fragment, it is a very rare phenomenon with less than fifty cases reported in the literature. Migration of the sequestrated segment is not only limited to the lumbar region, but has also been reported in the thoracic (2) as well as the cervical (3,4) segments. However, this is most commonly seen in the lumbar spinal segments and least in the cervical region.…”

Section: Introductionmentioning

confidence: 99%

PEMLIF—a tale of two stories

et al. 2017

View full text Add to dashboard Cite

A 48-year-old man was who had no previous history of back ache was involved in a strenuous activity wherein he had to lift weight of about 25 kg. Following this, he suddenly felt excruciating pain in the lower back radiating down to both his buttocks and knees. After sometime he felt weakness of both lower limbs and could not walk Abstract: Intervertebral disc prolapse is a common cause of both acute and chronic low back pain. This can result in differential grades of motor and sensory disturbances in lower limbs and even cauda equina syndrome (CES). The neurological manifestations are a result of compression of the spinal cord and roots ventrally in the spinal canal due to the prolapsed disc. However, neurologic deficits owing to compression of the spinal cord dorsally as a result of migration of sequestrated disc fragments are very rare. We present two different cases of back pain with severe neurologic deficit referred to us within a short span of one month. Among them, one had long standing history of back pain while other had none. Both patients were investigated and found to have a sequestrated disc fragment which had dorsally migrated to the epidural space and was causing severe compression of the spinal cord. They underwent laminectomy and removal of the sequestrated fragment. However, they were only partially relieved of their motor and bladder weakness.We present our cases to highlight this rare form of lumbar epidural intervertebral disc migration, as well as enumerate the diagnostic challenges and discuss the differential diagnosis and treatment.

show abstract

Dorsally Sequestered Cervical Disc Herniation

Cited by 6 publications

References 7 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 Sequestrated Cervical Disc Fragment: Case Series

PEMLIF—a tale of two stories

Contact Info

Product

Resources

About