Traumatic lumbar disc herniation mimicking epidural hematoma

Abstract

Rationale: We report a rare case of traumatic lumbar disc herniation mimicking epidural hematoma. Patient concerns: A 39-year old man presented with acute bilateral leg and back pain, following a crushing injury caused by a crane collapse. Diagnosis: A computed tomography scan revealed multiple compression fractures of the thoracolumbar spine, including a burst fracture of the L4 vertebral body. Magnetic resonance imaging (MRI) showed an epidural mass, extending longitudinally and causing dural sac compression behind the L3 vertebra. The mass had isosignal intensity on T1-weighted imaging and showed mixed high and low signals on T2-weighted imaging. On the basis of the patient's clinical history and imaging findings, our provisional diagnosis was an epidural hematoma following major trauma. Interventions: An emergency L3 laminectomy was performed with percutaneous screw fixation of L3-5. Intraoperatively, 3 large herniated disc fragments were found at L3 with no evidence of hematoma. Outcomes: The patient recovered normal motor function after surgery. At the last follow-up, 3 years after surgery, there was no residual neurological deficit apart from intermittent lower back pain. Lessons: In cases where MRI findings reveal an epidural lesion with a longitudinal shape, similar to an epidural hematoma, with mixed signal intensity on T2-weighted images and high peripheral signal intensity on T1-weighted images, traumatic disc herniation should be included in the differential diagnosis.

Double Level Non-Contiguous Traumatic Lumbar Disc Herniation Presenting With Cauda Equina Syndrome

“…We present a rare case of post-traumatic cauda equina syndrome, which was initially thought to be spinal epidural hematoma (SEH) but, intraoperatively, turned out to be double-level disc herniation. In the literature, only 6 cases of traumatic lumbar disc herniation have been reported, with 5 of them occurring at a single level [6][7][8][9][10][11] (Table I). So far, there is only 1 case of double-level lumbar disc herniation that has been reported by Siam et al in 2014.…”

Case Report and Literature Review: Lumbar Disc Extrusion Misdiagnosed as an Epidural Hematoma

“…In the literature, we found five other cases with diagnostic ambiguity like ours. We added our case to the tables done by Basile et al and Kim et al [16,17] (Table 1). *This information is not present in the articles nor described in the texts or legends.…”

“…In the literature, we found five other cases with diagnostic ambiguity like ours. We added our case to the tables done by Basile et al and Kim et al [ 16 , 17 ] (Table 1 ).…”

Traumatic lumbar disc extrusion mimicking spinal epidural hematoma: Case report and literature review

“…[7,8,9,13] ree of the abovementioned authors performed bilateral hemilaminectomy at the disc herniation level [7,8,13] while Kim et al performed right hemilaminectomy at the disc herniation level with percutaneous screw fixation of L3-5. [9] In spine trauma, conservative management is generally accepted as a first-line of management in cases without neurologic injury or gross instability. Typically, surgical intervention is required as the presence of neurological deficits.…”