Posterior Epidural Migration of a Lumbar Disc Herniation Causing Cauda Equina Syndrome: A Case Report

Hawkins, John C.; Natkha, Vitaliy P; Seibly, Jason

doi:10.7759/cureus.2739

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…Herniated PMEDF surprisingly are commonly present with cauda equina syndrome. Normally because the disc bulges posterolaterally surrounding and compressing the terminal spinal roots on a circumferential fashion at the lumbosacral level of origin [1]. To our knowledge only 8 cases have been reported until now as PMEDF 55% of patients with PMEDF present with cauda equina syndrome which makes early diagnosis of this condition critical because is well known that surgical treatment of cauda equina syndrome within 48 hours will improve the motor and sensory symptoms, in addition to bladder and rectal function [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…A lumbar disc herniation is defined as the protrusion of the nucleus pulposus beyond the normal boundaries of the fibrous annular ring [1]. A lumbar disc most commonly herniates in two directions, posterolateral direction or central herniation (anterior epidural space).…”

Section: Introductionmentioning

confidence: 99%

“…This occurs because it is limited by the presence of enforcing structures posterior to the disc, the posterior longitudinal ligament (PLL) and its related midline septum and lateral membranes [2]. As first reported by Lombardi in 1973, posterior epidural migration of a lumbar disc fragment (PEMLDF), the migration of disc materials that wrap around the thecal sac from anterior to the posterior epidural space, are a rare type of presentation [1,3]. PEMLDFs present as a lesion in the posterior epidural space on magnetic resonance imaging (MRI), which can mimic different pathologies such as epidural tumors, hematomas, facet cysts and abscess, making the diagnosis and treatment challenging [4].…”

Section: Introductionmentioning

confidence: 99%

“…PEMLDFs present as a lesion in the posterior epidural space on magnetic resonance imaging (MRI), which can mimic different pathologies such as epidural tumors, hematomas, facet cysts and abscess, making the diagnosis and treatment challenging [4]. The clinical presentation of patients with PEMLDF can range from lower back pain, nerve root irritation, radiculopathy and surprisingly common cauda equina syndrome [1,4]. Here we present the case of a 45-year-old male patient who presented with cauda equina syndrome, secondary to a PEMLDF that mimicked a lumbar facet joint cyst.…”

Section: Introductionmentioning

confidence: 99%

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Cauda Equina Syndrome after Sequestered Disc Herniation Migrating to the Dorsal Epidural Space: Case Report and Review of the Literature

AlShammari¹,

Weber²,

Navarro-Ramírez³

et al. 2020

SSG

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Background: Posteriorly migrated epidural disc fragments (PMEDF) presenting with cauda equina syndrome are relatively common. These cases are sometimes inaccurately identified on MRI as; epidural tumors, abscesses, hematomas and or facet cysts. Proper description and identification are key to be able to provide effective and safe management. Currently we are presenting the case of a patient with cauda equina syndrome secondary to a posterior mass compression intraoperatively identified as a PMEDF. Case Description: 45-years-old male presenting with insidious low back pain that progressed to urinary retention and bilateral foot drop. An MRI of the lumbar spine showed a posteriorly located epidural lesion. That appeared to be dependent on a left facet cyst. The patient was treated with a decompressive laminectomy and multiple disc fragments were identified under the ligamentum flavum and over the posterior epidural space. Conclusion: Posterior epidural migration of a lumbar disc fragments (PEMLDF) are not a common presentation of intervertebral disc herniations and their differential diagnosis and treatment might require a different surgical approach; fusion vs decompression. PEMLDFs should be suspected on those patients presenting with sudden cauda equina syndrome and posteriorly located epidural lesions on MRI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cauda Equina Syndrome after Sequestered Disc Herniation Migrating to the Dorsal Epidural Space: Case Report and Review of the Literature

AlShammari¹,

Weber²,

Navarro-Ramírez³

et al. 2020

SSG

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“…Hawkins [23] L4-5, 1 Back pain and a recent, acute progression of bilateral lower extremity (TA, EHL < grade 3/5) paresthesias and weakness.…”

Section: Table 1 Continuedmentioning

confidence: 99%

Posterior epidural sequestrated disc presenting with contralateral radiculopathy: a very rare case

Kesornsak

Wasinpongwanich

Kuansongtham

2021

Spinal Cord Ser Cases

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INTRODUCTION:Posterior epidural sequestrated disc is a fairly uncommon condition. We report a case of an unusual presentation of posterior epidural migration with contralateral symptoms. We emphasize a high index of suspicion for early recognition and treatment to promote a good neurological recovery. CASE PRESENTATION: A 58-year-old man with a history of severe back pain for 1 week developed sudden right leg weakness while walking. Neurological examination revealed motor and sensory impairments of the right lower extremities (positive right straight leg raising test, right tibialis anterior grade 2/5, right extensor hallucis longus grade 1/5, decreased pinprick sensation of L4-5 dermatome right side) according to the Standards for Neurological Classification of Spinal Cord Injury as Asia Impairment Scale D. Magnetic resonance images showed an acute disc herniation at L4-5 on the left side, cranially migrated and sequestrated to the posterior epidural area, causing severe compression to the cauda equina in the thecal sac. The patient was successfully treated with surgery (transforaminal lumbar interbody fusion) on an urgent basis. We saw significant neurological recovery on the first day after surgery. Motor power recovery was achieved with a minor deficit at 4 weeks. At the follow-up examination at 3 months, the patient had no residual neurological deficits as Asia Impairment Scale E. DISCUSSION: Posterior epidural sequestrated disc with contralateral radiculopathy is very rare. This case brings a new presentation of posterior epidural sequestrated disc. To our knowledge, this is the first report of a case with an unusual presentation of contralateral radiculopathy.

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Posterior epidural migration of herniated lumbar disc fragment: a literature review

2019

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Posterior Epidural Migration of a Lumbar Disc Herniation Causing Cauda Equina Syndrome: A Case Report

Cited by 4 publications

References 5 publications

Cauda Equina Syndrome after Sequestered Disc Herniation Migrating to the Dorsal Epidural Space: Case Report and Review of the Literature

Cauda Equina Syndrome after Sequestered Disc Herniation Migrating to the Dorsal Epidural Space: Case Report and Review of the Literature

Posterior epidural sequestrated disc presenting with contralateral radiculopathy: a very rare case

Posterior epidural migration of herniated lumbar disc fragment: a literature review

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