Migration postérieure d’une hernie discale lombaire responsable d’un syndrome de la queue-de-cheval

Elgamri, A; Sami, A.; Aqqad, A.; Hilmani, S.; Ibahioin, K.; Naja, A.; Kamar, A. El; Azhari, A. El

doi:10.1016/s0221-0363(09)74728-6

Cited by 17 publications

(4 citation statements)

References 14 publications

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“…In a report by Solnes et al, a 32-year-old woman with metastatic breast cancer was noted to develop symptoms consistent with CES [9]. In addition to these, epidural disc fragment migration is also an uncommon, yet, significant cause of CES [10-13].…”

Section: Discussionmentioning

confidence: 99%

A Successful Outcome Despite Delayed Intervention for Cauda Equina Syndrome in a Young Patient with a Posterior Epidural Disc Extrusion

Mugge

Caras

Miller

et al. 2019

Cureus

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Epidural disc extrusion is extremely rare and may cause cauda equina syndrome. This is a surgical emergency and needs rapid decompression. Although cauda equina is commonly caused by disc herniation, this is an unusual presentation with epidural disc extrusion. We present a very rare case of Cauda Equina syndrome, resulting from an epidural disc extrusion at L3-L4 level. Patient care and progress notes were reviewed along with pre-, post-, and intra-operative radiological imaging. Here, a 19-year-old male with a past medical history of type I diabetes mellitus, fell asleep on a chair at home in an unusual position and was unable to walk on awakening. The patient developed progressive neurological deficits including bilateral foot drop along with bowel and bladder dysfunction. In addition, he experienced paresthesia and severe lower back pain unresponsive to steroids. Pre-operative magnetic resonance imaging (MRI) demonstrated a herniated disk epidurally with disc extrusion and mass effect and compression at the L3-L4 level, wrapping around the posterior aspect of the dura. A diagnosis of cauda equina syndrome was made and surgical decompression was performed. Using microsurgical technique and fluoroscopic guidance, a bilateral laminectomy of L3 was achieved with bilateral partial laminectomy of L4, with bilateral foraminotomy of L4. After removal of the lamina, a mass was immediately visualized in the posterior epidural space. Further dissection of the substance and following it posteriorly, identified the mass as a portion of the extruded disc. Post-operatively, the patient experienced rapid recovery. In conclusion, this case demonstrates that a disc extrusion can occur within the epidural space and can cause cauda equina syndrome. As this presentation is unusual, surgeons must be aware that they may encounter disc mass in unexpected locations, in a clinically delayed setting, long after the initial onset of symptoms.

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Section: Discussionmentioning

confidence: 99%

A Successful Outcome Despite Delayed Intervention for Cauda Equina Syndrome in a Young Patient with a Posterior Epidural Disc Extrusion

Mugge

Caras

Miller

et al. 2019

Cureus

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“…The extruded disc usually migrates through anatomical corridors represented by the “midline septum” and “lateral membrane” [11, 12] and therefore posterior and contralateral migration are extremely rare eventualities. Posterior migration has been reported in about 70 cases in the literature, mostly involving L3-L4 [10], commonly presenting with polyradiculopathies and cauda equina syndrome [1–6].…”

Section: Discussionmentioning

confidence: 99%

“…T1w, T2w, STIR, and T1w gadolinium enhanced sequences are mandatory to achieve diagnosis [1, 3]. In the vast majority of cases (up to 80% [1, 9–12]), the extruded disc material is iso/hypointense in T1w and hyperintense in T2w. The inflammatory changes in the local environment cause an increased fluid content in the extruded material which is responsible for T2w hyperintensity [2, 3].…”

Section: Discussionmentioning

confidence: 99%

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

Frati

Pesce

Palmieri

et al. 2017

Case Reports in Surgery

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Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots.

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“…[ 1 ] The differential diagnoses include metastasis, chondrosarcoma, cystic schwannomas, abscess, or even epidural hematomas. [ 2 3 ]…”

Section: Discussionmentioning

confidence: 99%

Posterior epidural migration of lumbar disc: Will the real “disc” please stand up?

Deora¹,

Prabhuraj²,

Pruthi³

2017

Surg Neurol Int

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Background:Posterior epidural lumbar disc fragment migration is rare and most commonly occurs at the L3-L4 level where it may contribute to cauda equina compression.Case Description:Here, we report three cases of epidural migration of a lumbar disc, two of which led to bladder dysfunction/cauda equina compression. Early decompression (e.g., laminectomy) and aggressive postoperative physiotherapy led to significant postoperative improvement in all three patients.Conclusion:Migration of large sequestrated lumbar disc herniations leading to cauda equina compression should be recognized early and promptly treated with decompressive laminectomies to achieve the best postoperative outcomes.

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Migration postérieure d’une hernie discale lombaire responsable d’un syndrome de la queue-de-cheval

Cited by 17 publications

References 14 publications

A Successful Outcome Despite Delayed Intervention for Cauda Equina Syndrome in a Young Patient with a Posterior Epidural Disc Extrusion

A Successful Outcome Despite Delayed Intervention for Cauda Equina Syndrome in a Young Patient with a Posterior Epidural Disc Extrusion

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

Posterior epidural migration of lumbar disc: Will the real “disc” please stand up?

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