Posterior Epidural Migration of Sequestrated Cervical Disc Fragment: Case Series

Abstract

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.

The Cervical Sequestrated Disc Fragment Presenting as Mass Lesion: Case Report and Review of the Literature

“…The sequestration disc herniation occurs in rare cases and can migrate to rostral, caudal and lateral direction (1). Although MRI Abstract > Iranian Journal of Neurosurgery is the best diagnostic tool in the cases of disc herniation, in some cases of the sequestrated disc fragment, the diagnosis can be confused with other pathologies and other occupying, mass lesion and only surgery can lead to the exact diagnosis (3)(4)(5)6,7).…”

“…When disc fragment is connected to intervertebral disc and contain Annulus, not connected to intervertebral disc and only contain posterior longitudinal ligament (PLL) and when is free within spinal canal called protrusion, extrusion and sequestration, respectively (2). The sequestrated disc herniation can migrate rostral, caudal and lateral direction commonly and to posterior, in rare cases (1,3). MRI can be a useful and reliable tool in diagnosis of disc herniation disease (2) because of its availability in most regions.…”

“…Cervical disc herniation is one of the most common causes of cervical pain and limb neurologic deficit (1). Disc herniation is defined as the prolapsed of material disc into the spinal canal (2).…”

PEMLIF—a tale of two stories

“…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.…”

Cauda Equina Syndrome Following Traumatic Penetrating Lumbar Injury Caused by A Small Leather Fragment

“…Cauda equina syndrome (CES) is a serious neurological condition and the most common cause is a central disk herniation. [3][4][5][6][7] Migration of foreign bodies in the spinal canal has been rarely reported. 2 Very few case reports have been published on the onset of CES following penetrating wounds.…”