Document Detail


Posterior epidural migration of an extruded lumbar disc fragment causing cauda equina syndrome. Clinical and magnetic resonance imaging evaluation.
MedLine Citation:
PMID:  9507629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Retrospective case report. OBJECTIVES: To illustrate the rare occurrence of cauda equina syndrome resulting from posterior epidural disc fragment migration documented by magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: Disc fragment migration patterns are generally limited by the attachments of the posterior longitudinal ligament and its associated "midline septum" and "peridural" or "lateral membrane." The majority of symptomatic lumbar disc herniations are noted to be in a lateral position with resultant nerve root irritation. Although caudal, rostral, and lateral migration of disc fragments are common, posterior epidural migration of an extruded disc fragment has been reported only rarely, and only once in association with cauda equina syndrome. METHODS: The patient described in this report presented with an acute cauda equina syndrome. Investigation with magnetic resonance imaging revealed a posterior epidural mass, which was hypointense on T1-weighted and T2-weighted images. Postgadolinium imaging showed rim enhancement of the lesion. The preoperative differential diagnosis included epidural abscess, hematoma, or neoplasm. An urgent decompressive lumbar laminectomy was performed. At surgery, the lesion proved to be a massive extruded disc fragment. RESULTS: At the 1-year follow-up examination, the patient had recovered full motor, sensory, urologic, and sexual function. CONCLUSIONS: Extruded disc fragments may migrate posterior to the thecal sac. Magnetic resonance images of a posterior disc fragment may mimic those of other more common posterior epidural lesions.
Authors:
E A Bonaroti; W C Welch
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Spine     Volume:  23     ISSN:  0362-2436     ISO Abbreviation:  Spine     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-04-23     Completed Date:  1998-04-23     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  378-81     Citation Subset:  IM    
Affiliation:
University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Cauda Equina / pathology*
Epidural Space
Humans
Intervertebral Disk / pathology*
Intervertebral Disk Displacement / complications*,  pathology
Lumbar Vertebrae / pathology*
Magnetic Resonance Imaging
Male
Middle Aged
Nerve Compression Syndromes / etiology*,  pathology,  rehabilitation
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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