Dorsal Extradural Thoracic Disc Fragment

Abstract

Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.

Posteriorly migrated thoracic disc herniation: a case report

“…Posteriorly sequestrated disc herniation is rare but is sometimes reported in the lumbar spine [7]. However, to the best of our knowledge, only five cases of posteriorly migrated thoracic disc herniation have been reported in the English-language literature [1-5]. All reported patients with posteriorly migrated thoracic disc herniation, including our patient, were men with a mean age at onset of 54.7 years (range, 47 to 66 years) [1-5].…”

“…To the best of our knowledge, only five cases of posteriorly migrated thoracic disc herniation have been reported in the English-language literature [1-5]. We present herein an additional case of posteriorly migrated thoracic disc herniation.…”

Posterior Epidural Migration of Thoracic Disc Fragment

“…There have been reported several cases of posterior epidural migration of herniated disc fragments in lumbar area, but only four cases have been reported in thoracic area in the literature [2][3][4][5]8,12,[16][17][18][19][20] .…”

“…In our patient, there was communication between posterior epidural mass and the lateral protruded disc material. In most of the reported cases, preoperative diagnosis was difficult and confused with other posterior epidural space occupying lesions, such as hematoma, synovial cyst, epidural abscess, metastatic tumor, and meningioma [2][3][4][5]8,12,[16][17][18][19][20] . Hematoma usually has isointensity or hypointensity on T1WI, no enhancement, and an associated trauma history, but hematoma in resolving state can also appear as a rimenhancing lesion 7) .…”

“…Posterior epidural migration of herniated disc fragments are rare and most cases have been reported in lumbar region 2,4,5,8,12,17,19,20) . These posterior epidural migration in thoracic region are even more infrequent, with only four cases previously reported 3,[16][17][18] . We report a case of a 66-year-old man who presented with back pain and right leg weakness due to the posterior epidural migration of thoracic disc fragment.…”