Background: The migration of a herniated fragment of the intervertebral disc towards posterior epidural space remains an exceptional phenomenon and Its clinical presentation is not unequivocal. Its diagnosis in modern imaging can cause confusion with other lesions of the posterior epidural space. We report an unusual migration of a herniated disc fragment into the posterior epidural. Method: we describe a case of an unusual migration of disc fragment into the posterior epidural space admitted in Neurosurgery department of University Teaching Hospital of Cotonou in 2019. Result: A 33-year-old man was admitted for progressive bilateral radiculopathy, gait disturbances and constipation. The clinical examination noted a moderate perineum and right buttock hypoesthesia, a flaccid paraparesis, bilatéral straight leg raising limitation (45°). The right patellar and achilean reflexes were depressed. MRI of the lumbar spine showed a right L4L5 herniated disc and its migration into the anterolateral epidural space. Surgery was performed with posterior approach. After an L4 and L5 laminectony, we discovered a very compressive large fragment of L4L5 intervertebral disc. The fragment was delicately dissociated from its dural adhesions. Histological examination confirmed the fibrocartilaginous nature of the sample. The post-operative period was uneventful. Three months post-operatively, he had regained his autonomy with a strength score of 5/5 in both pelvic limbs. Conclusion: Migration of intervertebral disc fragment into the posterior epidural space is a rare phenomenon. Diagnosis errors are possible. In case of posterior migration with cauda equina syndrom, we recommend laminectomy with removal of herniated disk fragment. This approach remains a simple and secure.
| Published in | International Journal of Neurosurgery (Volume 4, Issue 1) |
| DOI | 10.11648/j.ijn.20200401.13 |
| Page(s) | 11-13 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2020. Published by Science Publishing Group |
Disc Migration, Herniated Disc, Posterior Epidural Space
| [1] | S. B. B. M C Ba, R Kleib, C Sy, J Diabang, N Ndoye, A B Thiam, M Thioub, I Tine, “Lumbar Disc Hernia Migrating To The Epidural Posterior Space: A Rare Entity,” Internet J. Neurosurgery., vol. 10, no. 1, pp. 1–6, 2014. |
| [2] | A. E. Elsharkawy, A. Hagemann, and P. D. Klassen, “Posterior epidural migration of herniated lumbar disc fragment: a literature review,” Neurosurgical Review, vol. 42, no. 4. Springer Verlag, pp. 811–823, 01-Dec-2019. |
| [3] | A. E. Elsharkawy, E. Gafumbegete, and P. D. Klassen, “Posterior epidural migration of extruded lumbar disc fragment mimicking epidural mass: A case report,” Interdiscip. Neurosurg. Adv. Tech. Case Manag. vol. 11, pp. 31–33, Mar. 2018. |
| [4] | A. Akhaddar, A. El-Asri, and M. Boucetta, “Posterior epidural migration of a lumbar disc fragment: A series of 6 cases - A review,” Journal of Neurosurgery: Spine, vol. 15, no. 1. pp. 117–124, Jul-2011. |
| [5] | K. Tarukado, O. Tono, and T. Doi, “Ordinary disc herniation changing into posterior epidural migration of lumbar disc fragments confirmed by magnetic resonance imaging: A case report of a successful endoscopic treatment,” Asian Spine J., vol. 8, no. 1, pp. 69–73, 2014. |
| [6] | J. S. Kim, S. H. Lee, and N. J. Arbatti, “Dorsal extradural lumbar disc herniation causing cauda equina syndrome: A case report and review of literature,” J. Korean Neurosurg. Soc., vol. 47, no. 3, pp. 217–220, Mar. 2010. |
| [7] | A. Sengoz, K. Kotil, E. Tasdemiroglu, “Posterior Epidural Migration of Herniated Lumbar Disc Fragment,” J Neurosurg Spine, vol. 14, no 3, pp 313-7, mar 2011. |
| [8] | S. M. Bouya, B. O. Djoubairou, N. Okacha, M. Gazzaz, and B. El Mostarchid, “Posterior epidural migration of lumbar intervertebral fragment: Case report,” Pan Afr. Med. J., vol. 21, pp. 1–5, 2015. |
| [9] | S. G. Teufack, H. Singh, J. Harrop, J. Ratliff, ”Dorsal Epidural Intervertebral Disk Herniation With Atypical Radiographic Findings: Case Report and Literature Review”, J Spinal Cord Med, vol 33, no 3, pp. 268-71, 2010. |
| [10] | R. K. Kutty, B. S. Sunilkumar, A. Peethambaran, S. K. Jain, S. Kumar, ”PEMLIF-a Tale of Two Stories”, J Spine Surg, vol 3, no 3, pp. 498-503, Sep 2017. |
| [11] | K. Haddadi and H. R. G. Qazvini, “Posterior epidural migration of a sequestrated lumbar disk fragment causing cauda equina syndrome in an old patient: A case report,” Clin. Med. Insights Case Reports, vol. 9, pp. 39–41, 2016. |
| [12] | A. Elgamri et al., “Migration postérieure d’une hernie discale lombaire responsable d’un syndrome de la queue-de-cheval,” J. Radiol., vol. 90, no. 6, pp. 731–733, 2009. |
| [13] | F. C. Tamburrelli, A. Perna, M. S. Oliva, I. Giannelli, M. Genitiempo,” Unusual Posterior Epidural Migration of Intervertebral Herniated Disc: A Report of Two Cases,” Malays Orthop J, vol. 12, no 3, pp. 47-49, Nov 2018. |
| [14] | S. G. Teufack, H. Singh, J. Harrop, and J. Ratliff, “Dorsal epidural intervertebral disk herniation with atypical radiographic findings: Case report and literature review,” J. Spinal Cord Med., vol. 33, no. 3, pp. 268–271, 2010. |
APA Style
Alihonou Thierry, Quenum Kisito, Ouiminga Karim, Takin Romulus, Fatigba Olatundji Holden. (2020). An Unusual Intraoperative Lumbar Disc Herniation Migrating into the Posterior Epidural Space. International Journal of Neurosurgery, 4(1), 11-13. https://doi.org/10.11648/j.ijn.20200401.13
ACS Style
Alihonou Thierry; Quenum Kisito; Ouiminga Karim; Takin Romulus; Fatigba Olatundji Holden. An Unusual Intraoperative Lumbar Disc Herniation Migrating into the Posterior Epidural Space. Int. J. Neurosurg. 2020, 4(1), 11-13. doi: 10.11648/j.ijn.20200401.13
AMA Style
Alihonou Thierry, Quenum Kisito, Ouiminga Karim, Takin Romulus, Fatigba Olatundji Holden. An Unusual Intraoperative Lumbar Disc Herniation Migrating into the Posterior Epidural Space. Int J Neurosurg. 2020;4(1):11-13. doi: 10.11648/j.ijn.20200401.13
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijn.20200401.13,
author = {Alihonou Thierry and Quenum Kisito and Ouiminga Karim and Takin Romulus and Fatigba Olatundji Holden},
title = {An Unusual Intraoperative Lumbar Disc Herniation Migrating into the Posterior Epidural Space},
journal = {International Journal of Neurosurgery},
volume = {4},
number = {1},
pages = {11-13},
doi = {10.11648/j.ijn.20200401.13},
url = {https://doi.org/10.11648/j.ijn.20200401.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20200401.13},
abstract = {Background: The migration of a herniated fragment of the intervertebral disc towards posterior epidural space remains an exceptional phenomenon and Its clinical presentation is not unequivocal. Its diagnosis in modern imaging can cause confusion with other lesions of the posterior epidural space. We report an unusual migration of a herniated disc fragment into the posterior epidural. Method: we describe a case of an unusual migration of disc fragment into the posterior epidural space admitted in Neurosurgery department of University Teaching Hospital of Cotonou in 2019. Result: A 33-year-old man was admitted for progressive bilateral radiculopathy, gait disturbances and constipation. The clinical examination noted a moderate perineum and right buttock hypoesthesia, a flaccid paraparesis, bilatéral straight leg raising limitation (45°). The right patellar and achilean reflexes were depressed. MRI of the lumbar spine showed a right L4L5 herniated disc and its migration into the anterolateral epidural space. Surgery was performed with posterior approach. After an L4 and L5 laminectony, we discovered a very compressive large fragment of L4L5 intervertebral disc. The fragment was delicately dissociated from its dural adhesions. Histological examination confirmed the fibrocartilaginous nature of the sample. The post-operative period was uneventful. Three months post-operatively, he had regained his autonomy with a strength score of 5/5 in both pelvic limbs. Conclusion: Migration of intervertebral disc fragment into the posterior epidural space is a rare phenomenon. Diagnosis errors are possible. In case of posterior migration with cauda equina syndrom, we recommend laminectomy with removal of herniated disk fragment. This approach remains a simple and secure.},
year = {2020}
}
TY - JOUR T1 - An Unusual Intraoperative Lumbar Disc Herniation Migrating into the Posterior Epidural Space AU - Alihonou Thierry AU - Quenum Kisito AU - Ouiminga Karim AU - Takin Romulus AU - Fatigba Olatundji Holden Y1 - 2020/03/03 PY - 2020 N1 - https://doi.org/10.11648/j.ijn.20200401.13 DO - 10.11648/j.ijn.20200401.13 T2 - International Journal of Neurosurgery JF - International Journal of Neurosurgery JO - International Journal of Neurosurgery SP - 11 EP - 13 PB - Science Publishing Group SN - 2640-1959 UR - https://doi.org/10.11648/j.ijn.20200401.13 AB - Background: The migration of a herniated fragment of the intervertebral disc towards posterior epidural space remains an exceptional phenomenon and Its clinical presentation is not unequivocal. Its diagnosis in modern imaging can cause confusion with other lesions of the posterior epidural space. We report an unusual migration of a herniated disc fragment into the posterior epidural. Method: we describe a case of an unusual migration of disc fragment into the posterior epidural space admitted in Neurosurgery department of University Teaching Hospital of Cotonou in 2019. Result: A 33-year-old man was admitted for progressive bilateral radiculopathy, gait disturbances and constipation. The clinical examination noted a moderate perineum and right buttock hypoesthesia, a flaccid paraparesis, bilatéral straight leg raising limitation (45°). The right patellar and achilean reflexes were depressed. MRI of the lumbar spine showed a right L4L5 herniated disc and its migration into the anterolateral epidural space. Surgery was performed with posterior approach. After an L4 and L5 laminectony, we discovered a very compressive large fragment of L4L5 intervertebral disc. The fragment was delicately dissociated from its dural adhesions. Histological examination confirmed the fibrocartilaginous nature of the sample. The post-operative period was uneventful. Three months post-operatively, he had regained his autonomy with a strength score of 5/5 in both pelvic limbs. Conclusion: Migration of intervertebral disc fragment into the posterior epidural space is a rare phenomenon. Diagnosis errors are possible. In case of posterior migration with cauda equina syndrom, we recommend laminectomy with removal of herniated disk fragment. This approach remains a simple and secure. VL - 4 IS - 1 ER -
Information
Email: