Türk Nöroşirürji Dergisi
2015 , Vol 25 , Num 1
Posterior Epidural Migration of Lumbar Disc Fragment: Report of Th ree Cases and Review of the Literature
1Başkent Üniversitesi, Tıp Fakültesi, Adana Uygulama ve Araştırma Merkezi, Beyin ve Sinir Cerrahisi Anabilim Dalı, Adana, Türkiye2Başkent Üniversitesi, Tıp Fakültesi, Ankara Hastanesi Beyin ve Sinir Cerrahisi Anabilim Dalı, Ankara, Türkiye Migration of lumbar disc fragments to the posterior epidural space is extremely rare. It is usually together with severe neurological deficits. In this article, three posterior epidural migrated (PEM) disc cases are reported together with the epidemiology, clinical findings, imaging features and treatment results and a literature review. Two patients had radicular syndrome and one patient had cauda equina syndrome (CES). Lumbar magnetic resonance imaging examinations of the patients revealed a nonspecific mass at the posterior epidural space, compressing the dural sac. Patients underwent surgical treatment. During surgery, the lesion proved to be herniated disc fragments. Clinical symptoms were improved in all patients at postoperative neurological examination.
Diagnosis of PEM of the sequestrated discs may be diff icult. It can be misdiagnosed as a posterior space-occupying lesion such as abscess, hematoma, or tumor. Clinical symptoms are often similar to lumbar disc hernia with CES, lumbago and radiculopathy constituting the main symptoms. CES is the most common symptom. Posteriorly migrated disc fragments are usually located at the upper lumbar levels. Thus, a defect in the anatomical barrier at the upper lumbar levels seems to be an etiological factor. As the surgical results are satisfactory despite severe neurodeficits in cases published in the literature, the importance of rapid diagnosis and treatment is increased.
Anahtar Kelimeler : Lumbar disc fragment, Posterior epidural space, Sequestered disc migration