Two Cases of Dorsal Epidural Migration of Lumbar Disk Fragments

This report presents 2 cases of migration of the lumbar disk into the dorsal epidural space. A 65-year-old man complained of sciatica and numbness from the posterior surface of the bilateral thighs. Magnetic resonance imaging (MRI) showed a narrow spinal canal at L3-4. The mass was posterolateral in the epidural space at the L4 level. It was iso-hypointense on T1-weighted images and iso-hyperintense on T2-weigted images. A decompressive lumbar hemilaminectomy was performed. Surgery revealed the mass to be surrounded by a membranous thickened mass of the epidural venous plexus and was dorsal to the dural sac. The mass proved to be a migrated lumbar disk fragment. The patient made a good recovery after surgery. A 73-year-old man complained of lumbar pain and right leg pain in the L5 area. MRI showed a lumbar disk hernia at L4-5. The mass was posterolateral in the epidural space at L5. It was iso-hypointense on T1-weighted images and iso-hyperintense on T2-weigted images. Surgery revealed that the mass was surrounded by a fibrous membrane with epidural venous plexus and was dorsal to the dural sac. It was determined to be a migrated lumbar disk fragment. The patient made a good recovery after surgery. The preoperative diagnosis of a migrated lumbar disk hernia is difficult to make based only on the findings of nonenhanced MRI images, and thus it must be considered in the preoperative differential diagnosis.
Source: Neurosurgery Quarterly - Category: Neurosurgery Tags: Case Reports Source Type: research