title: Extreme lateral disc herniation manifesting as nerve sheath tumor. Case report.
abstract: This report discusses the clinical features of a patient who presented with an L-3 radiculopathy in whom magnetic resonance imaging demonstrated what appeared to be a nerve sheath tumor in an extraforaminal location on the L-3 nerve root. A lateral intermuscular approach to excise the lesion was used to preserve the facet joint. Histological examination of the intraneural lesion revealed degenerative disc fragments. The authors hypothesize that the structure of the annulus fibrosus in the upper lumbar region predisposes these regions to lateral herniation. Furthermore, it is proposed that the lateral disc herniation allowed the disc fragments to erode through the epineurium of the neural sheath. This case expands the differential diagnosis of fusiform enlargement of nerves to include disc herniation.
authors.affiliation: Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: Cusimano
authors.forename: B P
authors.initials: BP
authors.lastname: Bukala
authors.forename: J
authors.initials: J
authors.lastname: Bilbao
mesh_terms: D000328:Adult; D001416:Back Pain / Q000209:etiology; D003937:Diagnosis, Differential; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D018317:Nerve Sheath Neoplasms / Q000175:diagnosis*; D011843:Radiculopathy / Q000175:diagnosis / Q000209:etiology; D013120:Spinal Cord Neoplasms / Q000175:diagnosis*; D013126:Spinal Nerve Roots / Q000473:pathology