Ann Rehabil Med.  2018 Aug;42(4):621-625. 10.5535/arm.2018.42.4.621.

Posterior Epidural Migration of a Lumbar Intervertebral Disc Fragment Resembling a Spinal Tumor: A Case Report

• Kim H
• Kwon BS
• Park JW
• Lee HJ
• Lee JW
• Lee EK
• Park TJ
• Kim HJ
• Cho Y
• Kim T
• Nam K

• KMID: 2420056
• DOI: http://doi.org/10.5535/arm.2018.42.4.621

Abstract

Posterior epidural migration of a lumbar intervertebral disc fragment (PEMLIF) is uncommon because of anatomical barriers. It is difficult to diagnose PEMLIF definitively because of its relatively rare incidence and the ambiguity of radiological findings resembling spinal tumors. This case report describes a 76-year-old man with sudden-onset weakness and pain in both legs. Electromyography revealed bilateral lumbosacral polyradiculopathy with a mass-like lesion in L2-3 dorsal epidural space on lumbosacral magnetic resonance imaging (MRI). The lesion showed peripheral rim enhancement on T1-weighted MRI with gadolinium administration. The patient underwent decompressive L2-3 central laminectomy, to remove the mass-like lesion. The excised lesion was confirmed as an intervertebral disc. The possibility of PEMLIF should be considered when rim enhancement is observed in the epidural space on MRI scans and electrodiagnostic features of polyradiculopathy with sudden symptoms of cauda equina syndrome.

Keyword

Intervertebral disc displacement; Polyradiculopathy; Magnetic resonance imaging

MeSH Terms

Aged
Electromyography
Epidural Space
Gadolinium
Humans
Incidence
Intervertebral Disc Displacement
Intervertebral Disc*
Laminectomy
Leg
Magnetic Resonance Imaging
Polyradiculopathy
Gadolinium

Figure

• 

  Fig. 1. Preoperative magnetic resonance imaging findings of the lumbar spine: a mass-like 2.3 cm lesion was detected at the L2-3 level in the posterior epidural space. The lesion (arrows) was hyperintense on sagittal and axial T2- weighted images (A, D) and isointense to the intervertebral disc on sagittal and axial T1-weighted images (B, E). The lesion showed rim enhancement (arrow) on sagittal gadolinium-enhanced T1- weighted image (C).

• 

  Fig. 2. Gross appearance and photomicrograph of surgical specimen containing intervertebral disc fragment. (A) Gross specimen shows increased vascularized epidural tissue (white arrows) and degenerated intervertebral disc fragment tissue (black arrows). (B) Histopathologic findings show degenerated fibrocartilage (H&E, ×100).

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