Posterior epidural migration of extruded lumbar disc fragment mimicking epidural mass: A case report

Introduction: Posterior epidural migration of the lumbar disc fragment is a very rare pathological entity. The pathomechanisms remain unclear. Case presentation: The authors present the case of a 78-year-old Germans male with refractory low back pain. Contrast-MRI showed an epidural mass at the level L1–2 with rim contrast enhancement. The preoperative diagnosis based on the clinical and history of the patient was most probably sequestrated disc fragment migrated posteriorly; differential diagnosis included all other causes of posteriorly located epidural mass.A left interlaminar approach L1–2 was performed. A sticky, capsulated, semi-hard and mobile mass was removed from the posterior epidural spaces. Intraoperative a lateral till the ventral disc fragments were found. An annular tear was found and discectomy was performed. Pathological examination showed a disc tissue with degenerative changes. The patient was pain-free until the last follow-up at 5months. Conclusions: Correlation between relevant clinical information and radiological finding may help to detect the posterior migrated disc fragment

An intradural lumbar disc fragment with free migration: A case of a missed intradural disc herniation

Introduction: Intradural lumbar disc herniation (ILDH) is a very rare pathological entity. The pathomechanisms and the natural course remain unclear. Case presentation: The authors present the case of a 58-year-old Germans male with repetitive microdiscectomies (MD) and intraoperative missed diagnosis of ILDH. The patient underwent standard MD due to lumbar disc herniation (LDH) at the level L4/5. Incidental durotomy (ID) was sealed with a ventromedial patch. Postoperative course was uneventful. 14 months later the patient presented with a L4 radiculopathy, having his second MD at the level L3/4. At this point the radiological images showed already a free floating intradural fragment at the level S1, clinically not significant. As in the previous surgery, the postoperative course was uneventful. After 18 months, he presented again complaining of low back pain and electric-like attacks of pain along the right L5 root for the prior five months. Contrast-MRI revealed that the known intradural disc-mass migrated from S1 to the level L4/5. A left L4 hemilaminectomy was performed. The durotomy identified a hard, white, shiny mass. The patient was pain-free until the last follow-up at 13 months. Conclusions: Intraoperative manipulation of disc fragments in the presence of an ID potentially leads to iatrogenic ILDH