J Korean Soc Spine Surg.  2001 Sep;8(3):248-252. 10.4184/jkss.2001.8.3.248.

Posterior Epidural Migration of Herniated Lumbar Intervertebral Disc: Two Cases Report

• Cho YS
• Cho SD
• Kim BS
• Park TW
• Lew S
• Cho HJ

• KMID: 2209742
• DOI: http://doi.org/10.4184/jkss.2001.8.3.248

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.
RESULTS
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 follow-up.
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.

Keyword

Lumbar disc herniation; Posterior epidural migration

MeSH Terms

Diskectomy
Epidural Space
Follow-Up Studies
Humans
Intervertebral Disc*
Magnetic Resonance Imaging

Figure

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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).

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  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).

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  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.

Reference

1). Bonaroti EA, Welch WC. Posterior epidural migration of an extruded lumbar disc fragment causing cauda equina syndrome. Spine. 23:378–381. 1998.

2). Cho JL, Park YS, Han JH. Posterior epidural migration of a sequestrated intervertebral lumbar disc. A Case report. The J of Korean Orthop Assoc. 34:985–8. 1999.

3). Dillon WP, Kaseff LG, Knackstedt VE, Osborn AG. Computed tomogragphy and differential diagnosis of the extruded lumbar disc. Journal of Computer Assisted Tomography. 7(6):969–975. 1983.

4). Ebeling U, Reulen HJ. Are there typical localizations of lumbar disc herniations? A prospective study. Acta Neu -rochir(Wien). 117:143–8. 1992.

5). Fries JW, Abodeely DA, Vijungco JG, Yaeger VL, Gaffey WR. Computed tomography of herniated and extruded nucleus pulposus. Journal of Computer Assisted Tomography. 6:874–887. 1982.

6). Lutz JD, Smith RR, Jones HM. CT myelography of a fragment of a lumbar disc sequestrated posterior to the thecal sac. Am J Neuroradioigy. 11:610–11. 1990.

7). Manabe S, Tateishi A. Epidural migration of extruded cervical disc and its surgical treatment. Spine. 11:873–8. 1986.

8). Masaryk TJ, Ross JS, Mondic MT, Boumphery F, Bohlman H, Wilber G. High-resolution imaging of sequestered lumbar intervertebral discs. Am J Neuroradioigy. 7:709–711. 1986.

9). Modic MT, Feiglin DH, Pirano DW. Vertebral osteo-myelitis: assessment using MR. Radiology. 157:157–166. 1985.

10). Schellinger D, Manz HJ, Vidic B. Disk fragment migration. Radiology. 175:831–6. 1990.

11). Wiltse LL, Fonseca AS, Amster J, Dimartino P, Ravessoud FA. Relationship of the dura, Hofmann's ligaments, Baston's plexus and a fibrovascular membrane lying on the posterior surface of the vertebral bodies and attaching to the deep layer of the posterior longitudinal ligament: An anatomical, radiologic, and clinical study. Spine. 18:1030–43. 1993.