Posterior extradural migration of extruded thoracic and lumbar disc fragments: role of MRI

Abstract

We report three patients with a sequestrated disc fragment posterior to the thecal sac. The affected disc was lumbar in two cases and thoracic in the third. Disc fragment migration is usually limited to the anterior extra dural space. Migration of a disc fragment behind the dural sac is seldom encountered. MRI appears to be the method of choice to make this diagnosis. The disc fragments gave low signal on T1- and slightly high signal on T2-weighted images and showed rim contrast enhancement. The differential diagnosis includes abscess, metastatic tumour and haematoma.

Posterior Epidural Migration of Thoracic Disc Fragment

“…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) .…”

“…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] .…”

“…Herniated disc fragments are known to migrate within the spinal canal in rostral, caudal, and lateral directions 6,14,22). 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] .…”

“…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.…”

Posterior epidural migration of a sequestered lumbar Intervertebral disc fragment

“…As far as we know, our 9-case series of PEMSLIDF represents the largest to date. A detailed literature search yielded 60 cases with similar features since the original description of the condition (1,6,8-10, 12,14,15,17,19,20,22,[24][25][26][27][28][29][30][31][32][33][34]36,37,[41][42][43]45,[47][48][49][50][51][52][53][54]. This study aimed to assess the clinical and imaging properties of PEMSLIDF and to discuss its surgical treatment and postoperative outcomes.…”