Posterior epidural sequestrated disc presenting with contralateral radiculopathy: a very rare case

Abstract

INTRODUCTION:Posterior epidural sequestrated disc is a fairly uncommon condition. We report a case of an unusual presentation of posterior epidural migration with contralateral symptoms. We emphasize a high index of suspicion for early recognition and treatment to promote a good neurological recovery. CASE PRESENTATION: A 58-year-old man with a history of severe back pain for 1 week developed sudden right leg weakness while walking. Neurological examination revealed motor and sensory impairments of the right lower extremities (positive right straight leg raising test, right tibialis anterior grade 2/5, right extensor hallucis longus grade 1/5, decreased pinprick sensation of L4-5 dermatome right side) according to the Standards for Neurological Classification of Spinal Cord Injury as Asia Impairment Scale D. Magnetic resonance images showed an acute disc herniation at L4-5 on the left side, cranially migrated and sequestrated to the posterior epidural area, causing severe compression to the cauda equina in the thecal sac. The patient was successfully treated with surgery (transforaminal lumbar interbody fusion) on an urgent basis. We saw significant neurological recovery on the first day after surgery. Motor power recovery was achieved with a minor deficit at 4 weeks. At the follow-up examination at 3 months, the patient had no residual neurological deficits as Asia Impairment Scale E. DISCUSSION: Posterior epidural sequestrated disc with contralateral radiculopathy is very rare. This case brings a new presentation of posterior epidural sequestrated disc. To our knowledge, this is the first report of a case with an unusual presentation of contralateral radiculopathy.

Lumbar Disc Herniation with Contralateral Symptoms: A Case‐Series of 11 Patients and Literature Review

“…26 In some patients, there is no evidence of nerve compression on the symptomatic side and the traction force plays a bigger role. 7,17,24,28 According to Sucu and Gelal, the top of the herniated disc (five cases) protruded towards the ipsilateral side on imaging studies, thus there was unequal traction force generated on both sides of the nerve root. 7 The contralateral nerve was subjected to a greater force theoretically.…”

“…Due to the inconformity between symptoms and radiographic findings, the surgical approach remains controversial. Three surgical strategies have been proposed in the literature: (1) unilateral approach and discectomy on the side of the patient's symptoms 10,11 ; (2) unilateral approach and discectomy on the side of the disc herniation 7,12–17 ; and (3) bilateral laminectomy and discectomy 10,15,18–24 . Compared with the unilateral approach, a bilateral laminectomy will increase the operation time and complication risks.…”

“…Three surgical strategies have been proposed in the literature: (1) unilateral approach and discectomy on the side of the patient's symptoms 10,11 ; (2) unilateral approach and discectomy on the side of the disc herniation 7,[12][13][14][15][16][17] ; and (3) bilateral laminectomy and discectomy. 10,15,[18][19][20][21][22][23][24] Compared with the unilateral approach, a bilateral laminectomy will increase the operation time and complication risks. However, it is challenging to ensure the relief of symptoms via a unilateral approach through performing decompression on the symptomatic or disc-herniation side.…”