Background & Importance: Disc herniation is defined as the prolapsed of material disc into the spinal canal. If the disc fragment is free in spinal canal, it is called sequestration disc fragment. Occasionally, alteration in sequestration disc fragment makes the diagnosis of the disc herniation, challenging.Case Presentation: We reviewed a rare case of the cervical sequestrated disc herniation mimicking a spinal canal extradural abscess. The 55-year-old man presented cervical axial and radicular pain. Cervical spine MRI showed an extra-axial longitudinal mass behind C5 and C6 vertebral body association with anterior compression on cord. In T2 images of lesion, the signal intensity varied from isointense to hyperintense and marked peripheral enhancement with GD injection. After unilateral right C6 hemilaminectomy, a sequestrated disc fragment was resected from epidural space.
Conclusion:The histopathologic findings were in favor of sequestrated disc herniation. Although MRI is the main preoperative diagnostic tool for accurate diagnosis of the sequestrated disc herniation, the sequestrated disc fragment can show the variable features on MRI and can be misdiagnosed with the other space-occupying lesions.
Background and ImportanceCervical 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). In the cervical region, it occurs more commonly in the postrolateral (2). The herniated disc can take the form of protrusion, extrusion and sequestration (2). 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. Unusual cervical sequestrated disc herniation mimicking other pathologies is a very rare situation (4). Occasionally, alteration in sequestration disc fragment makes the diagnosis of the disc herniation challenging. Therefore, the sequestrated disc fragment can mimic other pathologies and differential diagnoses including tumoral mass, abscess, cyst and even hematoma (4,5). In this study, we review a rare case of the cervical sequestrated disc herniation mimicking a spinal canal extradural abscess.
Case PresentationA 55-year-old man was admitted with cervical axial and radicular pain in the right C6 root from 6 months ago. Physical examination showed mild weakness in the right distal muscles force, hypoesthesia in the right C6 root and generalized hyper-reflexia. The cervical spine MRI showed an extra-axial longitudinal mass behind C5 and C6 vertebral body association with anterior compression on cord. It was isointense to...