Sequestrated lumbar intervertebral disc in the posterior epidural space: a report on two cases and review of the literature

Lakshmanan, Palaniappan; Ahuja, Sashin; Lyons, K.; Howes, J; Davies, Paul

doi:10.1016/j.spinee.2005.09.009

Cited by 42 publications

(43 citation statements)

References 7 publications

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“…Posterior epidural migration of a lumbar disc (PEM) is an uncommon event and less than 50 cases have been reported in the literature 1-12. Posterior migration of a sequestered disc fragments is generally restricted by some anatomical constraints like PLL attachments, lateral and medial septums, epidural fat, epidural venous plexus and finally nerve roots 3,5,8,10 . In PEM of the lumbar disc, men outnumber the female with the ratio of 4 to1 and the patients of middle age are mostly affected 1,5,8,[10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

“…In PEM of the lumbar disc, men outnumber the female with the ratio of 4 to1 and the patients of middle age are mostly affected 1,5,8,[10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

“…Review of reported cases revealed that half of the cases were manifested with radiculopathy and the other half with cauda equina syndrome [1][2][3][4][5]8,12 . The plain radiographs does not give too much information, in particular with consideration of disc height which remains normal because of the rapidity of the events in PEM.…”

Section: Discussionmentioning

confidence: 99%

“…However, in T2-weighted images, its intensity is variable and can be shown as a hyperintense mass in about 80% of the cases and hypointense or isointense in the remaining 20% cases 1,3,9, In contrasted MRI, particularly if the a few days passes, it resembles a cyst like lesion with rim enhancement,. This phenomenon is due to wrapping of the sequestrated disc by newly formed vessels or neovascularization 3,5,8,10 . Since these radiological features mimic those of other common posterior epidural lesions, definite preoperative diagnosis cannot be made in all of the cases 3,10 .…”

Section: Discussionmentioning

confidence: 99%

“…Since these radiological features mimic those of other common posterior epidural lesions, definite preoperative diagnosis cannot be made in all of the cases 3,10 . Differential diagnosis based both on clinical and radiological features include rapid expansion of a pre-existing synovial cyst, hemorrhagic juxtafacet cysts, gout, cystic schwannomas, tumors and abscess 1,[3][4][5]6,[8][9][10] . Decision for urgent surgery should be the first step toward the elimination of pain and averting neurological deficit, particularly in the subjects with cauda equina syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome

Soufiani

Rahimizadeh

2013

Coluna/Columna

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Posterior epidural migration (PEM) of a sequestered free lumbar disc fragment is rare. The rarity is due to presence of several anatomical restraints which restrict a free fragment to move to the posterior compartment. This unusual presentation of disc herniation appeared in the literature either as a single case report or in small series from two to six cases. Herein two new demonstrative cases will be presented with a brief review of the literature.Keywords: Cauda equina; Intervertebral disc displacement; Intervertebral disc; Surgical procedures, operative. A 53-year old male was admitted because of weakness of the lower extremity and inability to void for a day. He described no considerable history in the last few weeks. Neurological examination showed some decrease strength score of 3/5 on dorsiflexion of both feet. The sensation of the saddle area was also disturbed with bladder dysfunction necessitating a Foley catheter. ResUMOMagnetic Resonance Image (MRI) revealed an isointense mass located posterior to the theca at L3-L4 level. It had the intensity relative to the intensity of the intervertebral disc showed in T1-weighted sagittal images (Figure 1a). The mass had heterogeneous intensity in T2-weighted sagittal and axial images (Figure 1b and 1c).The patient underwent surgery within a few hours later with diagnosis of ligamentum flavum or synovial cyst. Surprisingly, after L3 laminectomy a big disc fragment lying on the dura mater was found. The fragment's disc which was loosely adhered to the dura was detached with careful dissection (Figure 1d).Subsequently, the corresponding disc space which had a tear in its annulus was approached and degenerated disc material was removed.The patient was discharged with partial recovery a few days after surgery, however, he fully recover a month later.

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Section: Discussionmentioning

confidence: 99%

“…In PEM of the lumbar disc, men outnumber the female with the ratio of 4 to1 and the patients of middle age are mostly affected 1,5,8,[10][11][12] .…”

Section: Discussionmentioning

confidence: 99%