Journal List > J Korean Soc Spine Surg > v.8(3) > 1035950

Cho, Cho, Kim, Park, Lew, and Cho: Posterior Epidural Migration of Herniated Lumbar Intervertebral Disc

Abstract

Study Design

case report and review of the literature

Objectives

to report two cases of posterior epidural migration of herniated lumbar intervertebral disc and review the literature

Summary of Background Data

Posterior epidural migration of herniated lumbar intervertebral disc is extremely rare. The large size of the fragment eventually exceeded the limits of the anterior epidural space and the fragment subsequently settled posterior the thecal sac because of spatial and size constraints.

Materials and Methods

Two cases of herniation of intervertebral disc which were caused by posteriorly migrated disc material were treated surgically with open discectomy. The magnetic resonance images, surgical treatment and related literature are reviewed.

Result

Preoperative magnetic resonance images of the posterior epidural migration of herniated lumbar intervertebral disc showed a large epidural mass. The mass was of intermediate signal intensity on T1- weighted images, was of low signal intensity on T2- weighted images and was enhanced marginally with gadolinium- DTPA on T1- weighted images. Immediately after operation, a significant reduction of symptoms were achieved. The patients recovered fully at two year followup.

Conclusions

Lumbar disc herniation by posterior epidural migration of sequestered fragment can be diagnosed with clinical findings and MRI including Gadolinium- DTPA enhancement. It should be differentiated from epidural mass and could be managed surgically with good results

REFERENCES

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Fig. 1.
Patient 1. Magnetic resonance imaging(MRI) shows posterior epidural mass at L2-3 intervertebral disc level, which is intermediate signal intensity on T1-weighted sagittal ima ge(A), low signal on T2-weighted sagittal image(B). Gadolinium-DTPA enhanced T1-weighted sagittal (C) and axia l(D) image shows peripherally enhanced oval mass compressing the dural sac in posterior epidural space. On axial image(D) the anterior portion of the mass seems to be connected to the protruded disc(arrow).
jkss-8-248f1.tif
Fig. 2.
Representative portion of the removed tissue which is that of fibrocartilage composed principally of collage-nous fibrillar matrix and chondrocytes lie in short rows between matrix(H&E, × 200).
jkss-8-248f2.tif
Fig. 3.
Patient 2. The posterior epidural mass shows rim enhancement on Gadolinium-DTPA enhanced T1-weighted sagittal (A) and T2-weighted axial (B) image.
jkss-8-248f3.tif
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