Cauda equina compression due to posterior epidural migration of extruded lumbar disk

Dorsal migration of lumbar disc fragments causing cauda equina syndromes: A three case series and literature review

Background

Dorsal migration of an intervertebral lumbar disc fragment is exceedingly rare and may result in spinal cord or cauda equina compression. Radiologically, these lesions may be misdiagnosed as extradural masses or epidural hematomas.

Case Description

We present three cases involving dorsal migration of sequestered lumbar disc fragments resulting in cauda equina syndromes. A 31-year-old male, 79-year-old female, and 47-year-old female presented with cauda equina syndromes attributed to the migration of dorsal sequestered lumbar disc fragments. Prompt surgical decompression resulted in adequate outcomes. Here, we review the three cases and the current literature for such lesions.

Conclusion

Dorsal migration of sequestered lumbar disc fragments is exceedingly rare, and these lesions are frequently misdiagnosed as extradural masses of other origin or epidural hematomas. Here and in the literature, prompt epidural decompression both confirmed the correct diagnosis and resulted in excellent outcomes.

Dorsal epidural intervertebral disk herniation with atypical radiographic findings: case report and literature review

BACKGROUND/OBJECTIVE

Intervertebral disk herniation is relatively common. Migration usually occurs in the ventral epidural space; rarely, disks migrate to the dorsal epidural space due to the natural anatomical barriers of the thecal sac.

DESIGN

Case report.

FINDINGS

A 49-year-old man presented with 1 week of severe back pain with bilateral radiculopathy to the lateral aspect of his lower extremities and weakness of the ankle dorsiflexors and toe extensors. Lumbar spine magnetic resonance imaging with gadolinium revealed a peripheral enhancing dorsal epidural lesion with severe compression of the thecal sac. Initial differential diagnosis included spontaneous hematoma, synovial cyst, and epidural abscess. Posterior lumbar decompression was performed; intraoperatively, the lesion was identified as a large herniated disk fragment.

CONCLUSIONS

Dorsal migration of a herniated intervertebral disk is rare and may be difficult to definitively diagnose preoperatively. Dorsal disk migration may present in a variety of clinical scenarios and, as in this case, may mimic other epidural lesions on magnetic resonance imaging.