Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome

Abstract

Posterior epidural migration (PEM) of a sequestered free lumbar disc fragment is rare. The rarity is due to presence of several anatomical restraints which restrict a free fragment to move to the posterior compartment. This unusual presentation of disc herniation appeared in the literature either as a single case report or in small series from two to six cases. Herein two new demonstrative cases will be presented with a brief review of the literature.Keywords: Cauda equina; Intervertebral disc displacement; Intervertebral disc; Surgical procedures, operative. A 53-year old male was admitted because of weakness of the lower extremity and inability to void for a day. He described no considerable history in the last few weeks. Neurological examination showed some decrease strength score of 3/5 on dorsiflexion of both feet. The sensation of the saddle area was also disturbed with bladder dysfunction necessitating a Foley catheter. ResUMOMagnetic Resonance Image (MRI) revealed an isointense mass located posterior to the theca at L3-L4 level. It had the intensity relative to the intensity of the intervertebral disc showed in T1-weighted sagittal images (Figure 1a). The mass had heterogeneous intensity in T2-weighted sagittal and axial images (Figure 1b and 1c).The patient underwent surgery within a few hours later with diagnosis of ligamentum flavum or synovial cyst. Surprisingly, after L3 laminectomy a big disc fragment lying on the dura mater was found. The fragment's disc which was loosely adhered to the dura was detached with careful dissection (Figure 1d).Subsequently, the corresponding disc space which had a tear in its annulus was approached and degenerated disc material was removed.The patient was discharged with partial recovery a few days after surgery, however, he fully recover a month later.

Posterior epidural migration of a sequestered lumbar Intervertebral disc fragment

“…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.…”

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

“…The gold standard for diagnosis is a gadolinium enhanced lumbar spine MRI scan [1, 3, 9]. T1w, T2w, STIR, and T1w gadolinium enhanced sequences are mandatory to achieve diagnosis [1, 3].…”

“…T1w, T2w, STIR, and T1w gadolinium enhanced sequences are mandatory to achieve diagnosis [1, 3]. In the vast majority of cases (up to 80% [1, 9–12]), the extruded disc material is iso/hypointense in T1w and hyperintense in T2w. The inflammatory changes in the local environment cause an increased fluid content in the extruded material which is responsible for T2w hyperintensity [2, 3].…”

Myelography and residual contrast in panoramic radiography: case report

“…With the increasing use of CT scans and magnetic resonance imaging, the use of myelography decreased and, consequently, the use of iofendilate [11]. However, even though rare, myodil residues can still be visualized and can even be interpreted as diseases.…”