Lumbar disc sequestration mimicking a tumor: Report of four cases and a literature review

Abstract

BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space. Disc sequestration is defined as migration of the herniated disc fragment into the epidural space, completely separating it from the parent disc. The fragment can move in upward, inferior, and lateral directions, which often causes low back pain and discomfort, abnormal sensation, and movement of lower limbs. The free disc fragments detached from the parent disc often mimic spinal tumors. Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors, such as lumbar soreness, pain, numbness and weakness of lower limbs, radiation pain of lower limbs, etc . It is usually necessary to diagnose the disease according to the doctor's clinical experience, and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging (MRI) and contrast-enhanced MRI. However, pathological examination is the gold standard that distinguishes tumoral from non-tumoral status. We report four cases of disc herniation mimicking a tumor, and all the pathological results were intervertebral disc tissue. CASE SUMMARY The first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year, with exacerbation over the last 2 wk. After admission, MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment, with enhancement on contrast-enhanced MRI suggesting neurilemmoma. The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years, with exacerbation over the last 3 mo. MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level, with obvious peripheral enhancement on contrast-enhanced MRI. Thus, neurilemmoma was suspected. The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk. MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level, with obvious rim enhancement on contrast-enhanced MRI. Thus, a spinal tumor was suspected. The fourth case was a 75-year-old man with right lower extremity pain for 2 wk, with exacerbation over the last week. MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion. There was no obvious enhancement on contrast-enhanced MRI, so a spinal tumor was suspected. All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5, 8, 8, and 6, respectively. All patients had an uneventful postoperative course and fully recovered within 3 mo. CONCLUSION Disc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor. Examinations and tests should be improved preoperatively. Patients should undergo comprehensive preoperative evaluations, and the lesions should be re...

A Rare Case of Sequestered Intervertebral Disc Mimicking a Tumour

“…From literature review, it was shown that evidence of peripherally enhanced lesion in a contrast enhanced MRI may indicate presence of intervertebral disc, however in our case, peripheral enhancement was not seen [7]. Hence, absence of this criteria should not rule out presence of intervertebral disc.…”

“…The surgical outcome of our case is good with the patient able to regain full power of his lower limbs. Literature review also showed similar outcomes [2], [7], [8]. Thus, we suggest for prompt surgical intervention despite diagnostic dilemma, to ensure good prognosis.…”

A Severe Disc Herniation Mimics Spinal Tumor

“…Diagnosing large LDH may be challenging, and severe disc herniation often mimics spinal tumors [ 6 - 10 ]. Thorough medical history, clinical features, physical examination, and radiological examinations such as an MRI or computed tomography are also used to diagnose and evaluate the condition.…”

“…Diagnosing large LDH may be challenging, and severe disc herniation often mimics spinal tumors [6][7][8][9][10].…”

Imaging of Sequestered Lumbar Discs

“…특징적으로 신경초종은 종종 T2 강조영상에서 중심부 저신호강도와 주변부 고신호강도를 보이는 ‘표적 징후(target sign)’를 나타낸다. 이는 분리추간판 조각과는 반대되는 소견으로 주요 감별점이 될 수 있다( 41 ). 그러나 신경초종이 중심부에서 낭성변성을 보이는 경우에는 감별이 어려울 수 있다.…”