Posterior and anterior epidural and intradural migration of the sequestered intervertebral disc: Three cases and review of the literature

Dorsal migration of the sequestered lumbar intervertebral disc is an unusual and underrecognized pattern of lumbar disc herniation associated with pain and neurological deficit. Three patients presented with lower limb- and low back pain. MR imaging showed intracanalicular mass lesions with compress...

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Bibliographic Details
Published in:The journal of spinal cord medicine 2022-03, Vol.45 (2), p.305-310
Main Authors: Theodorou, Daphne J, Theodorou, Stavroula J, Kakitsubata, Yousuke, Papanastasiou, Evangelos I, Gelalis, Ioannis D
Format: Article
Language:English
Subjects:
Case Report
Case Reports
Epidural Space
Humans
Intervertebral Disc - pathology
Intervertebral Disc - surgery
Intervertebral Disc Displacement - diagnosis
Intervertebral Disc Displacement - diagnostic imaging
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - pathology
Lumbar Vertebrae - surgery
Magnetic Resonance Imaging
Spinal Cord Injuries - complications
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Summary:Dorsal migration of the sequestered lumbar intervertebral disc is an unusual and underrecognized pattern of lumbar disc herniation associated with pain and neurological deficit. Three patients presented with lower limb- and low back pain. MR imaging showed intracanalicular mass lesions with compression of the spinal cord and allowed precise localization of lesions in the extradural or intradural space. Diagnosis was straightforward for the patients with the posterior and anterior epidural disc fragments, whereas various differential diagnostic considerations were entertained for the patient with the intradural mass lesion. All patients underwent surgical removal of the sequestered disc fragments, and recovered full motosensory function. Surgical repair of the dura mater due to CSF leak was required for the patient with intradural disc herniation. Posterior and anterior epidural, and intradural disc migration may manifest with clinical symptoms indistinguishable from those associated with non-sequestered lumbar disc hernias. Missed, migrated disc fragments can be implicated as a cause of low back pain, radiculopathy or cauda equina syndrome, especially in the absence of visible disc herniation. A high index of suspicion needs to be maintained in those cases with unexplained and persistent symptoms and/or no obvious disc herniation on MR images.
ISSN:1079-0268
2045-7723
DOI:10.1080/10790268.2020.1730110