Sequestrated Lumbar Disc Herniation Mimicking Spinal Neoplasm

Abstract

Sequestered disc fragments do not have indistinctive features and often share the clinical and radiological presentation as spinal neoplasms making their diagnosis and treatment a clinical challenge.We report a rare case of sequestered lumbar disc fragment at the level of L2-L3 in a 70-year-old male who presented to the ER complaining of six years' history of low back pain with acute onset lower extremities weakness for six days, associated with right foot drop. He was admitted for tumor workup as the MRI showed diffuse bone high signal intensity throughout the spine with a soft tissue epidural mass at L2/3, causing severe compression on the cauda equina nerve roots. The patient underwent L2-L3 decompression and fixation, mass excision, multiple open biopsies. Soft tissue biopsy of the mass revealed fibrocartilaginous tissue consistent with the intervertebral disc, while the bone biopsy was diagnostic of acute leukemia. The patient was observed postoperatively with unremarkable complications. He did well with physiotherapy, and there was a remarkable improvement of his right lower extremity power reaching 4/5.Our case presented a rare phenomenon in which sequestered disc fragments manifested clinically and radiologically as a spinal neoplasm. Vigilant history taking and physical examination are paramount; a physician should be watchful for any red flags that may warrant further investigation such as in our case.