Posterior Epidural Migration of Lumbar Disc Fragment: Three Cases and Review of Literature

Posterior migration of lumbar disc herniation: A case report

“…Epidural abscesses usually appear as hypo T1 WI and hyperintense WI with peripheral rim enhancement. A hematoma appears iso-or hyperintense on T1 WI and heterogeneous hyperintense on T2 WI and is associated with risk factors for epidural anesthesia, trauma, and pregnancy [ [1] , [6] , [8] ].…”

“…For patients with posterior epidural migration of lumbar disc fragments, surgery is the treatment of choice to prevent severe neurological deficits such as cauda equina syndrome or conus medullaris syndrome. The optimal surgical management is removal of the extruded fragment by hemilaminectomy or laminectomy [ [1] , [8] , [9] , [10] ]. In this case, the presence of neurological deficit was an indication for surgical intervention.…”

Sudden Onset of Cauda Equina Syndrome Resulting from Posterior Migration of Lumbar Herniated Disc Without Significant Previous Neurological Signs

“…Gadolinium-enhanced MRI should be performed if possible, as most of the migrate disc fragments show peripheral rim enhancement. An enhancement is caused by an inflammatory response with granulation tissue and newly formed vessels around the sequestrated tissue that lead to hyper-hydration of the disc fragment 2 , 6) . Typically, the center of the disc herniation dose not become enhanced 11) .…”

“…Timing of surgical decompression is controversial, with results in certain studies showing that delayed surgery may provide a satisfactory outcome, and recovery of function may not be related to the time to surgical intervention 1) . However, most reports suggest that early surgery should be the first choice to prevent severe neurologic deficits and to improve clinical outcome in paraplegia caused by posterior epidural migration 6 , 7) . Deciding to conduct unilateral hemilaminectomy, total laminectomy, or fusion should be based on the size of the lesion 7) .…”

Posterior Epidural Migration of an Extruded Lumbar Disc Mimicking a Facet Cyst: A Case Report

“…Although lumbar disc extrusions are frequently observed in neurosurgical practice, posterior epidural migration of an extruded prolapsed intervertebral disc fragment is rare 4 , 6) . The migration of disc fragments is generally contained in the anterior epidural space, which is well defined and delineated by the posterior longitudinal ligament and by the lateral membranes attached to it 9) .…”