Korean J Spine.  2017 Sep;14(3):115-117. 10.14245/kjs.2017.14.3.115.

Posterior Epidural Herniation of a Lumbar Disk Fragment at L2–3 That Mimicked an Epidural Hematoma

• Kil JS
• Park JT

• KMID: 2396053
• DOI: http://doi.org/10.14245/kjs.2017.14.3.115

Abstract

Lumbar disk herniation is common. Because of the posterior longitudinal ligament, migration usually occurs into the ventral epidural space. Rarely, fragments migrate into the dorsal epidural space. A 57-year-old man presented with lower back pain and weakness on right hip flexion and right knee flexion. He had lower back pain 1 day previously and received a transforaminal epidural block at a local hospital. The next day, he reported weakness of the right lower extremity. Lumbar spine magnetic resonance imaging revealed a dorsal epidural lesion with compression of the thecal sac at L2-3. Initial differential diagnoses included epidural hematoma after the block, neoplasm, and a sequestrated disk. Posterior lumbar decompression was performed. The lesion was identified intraoperatively as a large herniated disk fragment. Posterior epidural herniation of a lumbar disk fragment is rare and may be difficult to diagnose preoperatively. It may present as a variety of clinical scenarios and, as in this case, may mimic epidural hematoma.

Keyword

Intervertebral disc; Herniation; Epidural space; Epidural Hematoma

MeSH Terms

Decompression
Diagnosis, Differential
Epidural Space
Hematoma*
Hip
Humans
Intervertebral Disc
Intervertebral Disc Displacement
Knee
Longitudinal Ligaments
Low Back Pain
Lower Extremity
Magnetic Resonance Imaging
Middle Aged
Spine