Lumbar Intervertebral Disc Herniation Masquerading as an Epidural Hematoma

Jain, Nikhil; Crouser, Nisha; Yu, Elizabeth

doi:10.2106/jbjs.cc.17.00300

Cited by 7 publications

(4 citation statements)

References 29 publications

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“…Notably, traumatic disc herniations, unlike epidural hematomas, usually regress in size over time. [2,3,[5][6][7]10,11,14] In our patient, the herniated mass showed a medium/high SI on the T1-weighted MRIs and high SI on T2-weighted MRIs [Figure 1]. e SI pattern on MRI we observed was the same as that of blood, and this led us to support the preliminary diagnosis of SEH.…”

Section: Discussion and Literature Reviewsupporting

confidence: 66%

“…We identified four similar reports of traumatic lumbar disk herniation mimicking epidural hematomas and we reported a table with comparable cases [Table 1]. [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.…”

Section: Discussion and Literature Reviewmentioning

confidence: 96%

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

Basile

Brunasso

Gerardi³

et al. 2020

Surgical Neurology International

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Background: Because the neurological presentation of spinal epidural hematomas (SEH) is often not specific, they may be misdiagnosed as acute lumbar disk herniations. Here, we present a case in which a traumatic disc extrusion mimicked an epidural hematoma and reviewed the appropriate literature. Case Description: A 27-year-old male sustained a high-energy fall. The lumbar MRI scan showed a L4-S1 ventral medium/high signal intensity mass on the T1- and high signal intensity lesion on T2-weighted images; the original diagnosis was spinal epidural hematoma. However, at surgery, consisting of a left L4 and L5 hemilaminectomy with L4-L5 and L5-S1 laminotomy, an extruded lumbar disc was encountered at the L4-L5 level and removed; no additional pathology or SEH was found at either level. Conclusion: On MR, SEH may mimic acute lumbar disk herniations. Depending on the clinical symptoms/signs, surgical intervention will both correctly confirm the diagnosis and relieve neural compression.

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Section: Discussion and Literature Reviewsupporting

confidence: 66%

Section: Discussion and Literature Reviewmentioning

confidence: 96%

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

Basile

Brunasso

Gerardi³

et al. 2020

Surgical Neurology International

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Naik,

Ramachandran,

Prasad Shetty

et al. 2024

JBJS Case Connector

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Case: A 52-year-old man presented with cauda equina syndrome after a motorcycle accident. Magnetic resonance imaging revealed traumatic disc herniation, at L2-L3 and L5-S1 levels without bony injury. He was managed successfully by wide laminectomy and microdiscectomy at both levels with complete neurological recovery at 2-month follow-up. Conclusion: With a reported incidence of 0.4%, traumatic disc herniation in the lumbar region is an uncommon occurrence that may resemble a spinal epidural hematoma in acute trauma. Although MRI may not reliably differentiate spinal epidural hematoma from disc herniation, urgent surgical intervention may be required in profound neurological deficits.

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“…In our patient, the herniated disc showed a mixture of high and low SI on the T2-weighted images and an iso SI with a high signal rim on the T1-weighted images similar to the SI of acute epidural hematoma, as reported in previous cases. [3,4] The herniated disc appeared as a longitudinal epidural mass with tapering tips at the L3-4 level and there was no definite continuity with the intervertebral disc space on both T1 and T2 weighted sagittal images. The provisional diagnosis performed based on trauma history and MRI findings was a spinal epidural hematoma; however, the possibility of hematoma associated with disc herniation could not be excluded.…”

Section: Discussionmentioning

confidence: 99%

Traumatic lumbar disc herniation mimicking epidural hematoma

Kim

Lee

et al. 2019

Medicine

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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.

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Lumbar Intervertebral Disc Herniation Masquerading as an Epidural Hematoma

Cited by 7 publications

References 29 publications

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

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

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

Traumatic lumbar disc herniation mimicking epidural hematoma

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