Posterior Epidural Migration of Sequestrated Cervical Disc Fragment: Case Series

Srinivasan, Uddanapalli Sreeramulu; Kumar, Gopalan Senthil; Mahesha, Kanthila Bhat

Abstract

STUDY DESIGN: A retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse. PURPOSE: To present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management. OVERVIEW OF LITERATURE: Non-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature.
METHODS
Detailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery.
RESULTS
T1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated.
CONCLUSIONS
We opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome.