Sequestered lumbar disc herniation mimicking spinal tumor

Biasi, Pedro Radalle; Mallmann, Adroaldo Baseggio; Crusius, Paulo Sérgio; Seibert, Cláudio Albano; Crusius, Marcelo Ughini; Crusius, Cassiano Ughini; Espanhol, Rafael Augusto; Brunet, Matheus Pintos; Carazzo, Charles André

doi:10.1055/s-0038-1626029

Cited by 5 publications

(8 citation statements)

References 6 publications

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“…No Brasil ainda se utiliza da tomografia axial computadorizada que, apesar de ser capaz de identificar uma hérnia de disco, não se aproxima da qualidade e tampouco da sensibilidade da ressonância magnética. Informações detalhadas de partes ósseas e de tecidos moles que podem ajudar não só no diagnóstico correto, mas até na proposta terapêutica, fazem da RM exame indispensável para a correta avaliação do paciente [1,11].…”

Section: Discussionunclassified

“…Extrusão aguda não compressiva do núcleo pulposo, nódulo de Schmorl e hérnia sequestrada são raras em cães, gatos, seres humanos e outras espécies, possui manifestação clínica variável, razão pela qual são pouco documentadas [1,2,6,11].…”

Section: Introductionunclassified

“…Os diagnósticos diferenciais das doenças discais incluem: neoplasias vertebrais, medulares ou meníngeas; cistos aracnoides; abscessos; discoespondilite; edema e/ou hemorragia intra ou extramedulares; distúrbios congênitos vertebrais ou medulares e mielopatias isquêmicas [1,5,11].…”

Section: Introductionunclassified

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Sequestered Disc Herniation in a Dog

Villanova

Dipp

Neto

et al. 2019

Acta Scientiae. Vet.

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Background: Dogs are frequently affected by intervertebral disc degeneration, a structural failure associated with changes accelerated by aging. Disc degeneration may occur in the presence or absence of clinical signs, which are variable and common to other spinal cord diseases and therefore early diagnosis is crucial to a successful outcome. Treatment may be conservative or surgical according to severity of the clinical signs and should be combined with a rehabilitation protocol. Prognosis depends on the location of the spinal cord compression, volume and velocity of the disc material herniation and time between initial clinical signs, definitive diagnosis and therapeutic approach. Case: A nonchondrodystrophic 14-year-old dog with acute clinical manifestation of paraparesis and proprioceptive deficit in hind limbs was submitted to myelography examination. There was contrast column deviation in the T13-L1 region, determining spinal compression, and spondyloses were also noted in several thoracolumbar vertebrae. Hemilaminectomy was performed with complete removal of the compressor fragment. Histological analysis confirmed the presence of fibrocartilaginous material that corresponds to the part of the annulus fibrosus. The kidnap of the fragment was characterized by loss of continuity with the remaining disk. In these cases, magnetic resonance imaging does provides the definitive diagnosis, since neoplasm, arachnoid cysts and abscesses may be remaining differential diagnosis. Therefore, surgical approach followed by histopathological analysis of the obtained material are necessary to confirm the diagnosis. Discussion: The present report differs from most cases of disc herniation because it is a thoracolumbar lesion with an acute manifestation of significant neurological deficit in an elderly dog of non-chondrodystophic breed. Also, material of the free fibrous annulus itself in the medullary canal is not a common histopathological presentation of disc extrusion usually composed by nucleus pulposus. After neurolocalization of the lesion by clinical neurological examination, the radiographic evaluation shall precedes the myelography, since this is contraindicated when there is suspicion of discoespondylitis, fracture, dislocation or vertebral subluxation, which had not yet been discarded. Even if the MRI is performed, in the cases of a sequestered fragment, it still remais differential diagnoses include arachnoid cysts, discoespondylitis, hematomas, abscesses and neoplasms, including metastases, so only surgical approach to obtain material for histopathological analysis may provide definitive diagnosis. According to the histopathological examination, the herniated material had a fibrocartilaginous characteristic: several concentric fibrous blades, composed of collagen and fibrocartilage, thus characterizing the herniated material as a fragment of the fibrous ring. When removed from the vertebral canal, the contents did not show resistance, being withdrawn completely and without continuity with its origin intervertebr...

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Section: Discussionunclassified

Section: Introductionunclassified

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Sequestered Disc Herniation in a Dog

Villanova

Dipp

Neto

et al. 2019

Acta Scientiae. Vet.

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“…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). The differential diagnosis includes abscess and infections, benign and malignant neoplasm, metastasis as well as cyst.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Background and Importancementioning

confidence: 99%

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

Babashahi

Taheri

2016

IrJNS

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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...

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