Sequestrated lumbar intervertebral disc in the posterior epidural space: a report on two cases and review of the literature.
BACKGROUND
Posterior epidural migration is an interesting but rare path taken by a prolapsed intervertebral disc fragment. There are only seven cases reported of a similar migration of the disc fragment in the lumbar spine.


OBJECTIVE
To diagnose the unusual presentation and interpretation of the sequestrated disc in the posterior epidural space.


METHODS
Case report.


METHODS
Two cases of migration of the sequestrated disc into the posterior epidural space are presented. In one patient there was weakness of the ankle dorsiflexors, foot invertors, and toe extensors of the left foot, with sensory loss over the back of the calf and over the lateral three toes. The left ankle jerk was also absent. However, in the other case, there was no objective evidence of neurological deficit distally.


RESULTS
Gadolinium magnetic resonance imaging scans showed ring enhancement preoperatively. Biopsy of the specimen taken from surgery confirmed it to be sequestrated disc fragment.


CONCLUSIONS
Diagnosis of posterior epidural migration of the sequestrated discs may be difficult. It may present with subtle clinical features even though the disc transgresses through numerous anatomic restraints including the nerve roots in such cases.
Lakshmanan
Palaniappan
P
University Hospital of Wales, Cardiff, UK. lakunns@gmail.com
Ahuja
Sashin
S
Lyons
Kathleen
K
Howes
John
J
Davies
Paul Rhys
PR
D000328:Adult; D004824:Epidural Space; D005260:Female; D005548:Foreign-Body Migration; D005682:Gadolinium; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D011128:Polyradiculopathy / Q000209:etiology / Q000473:pathology* / Q000601:surgery
D005682:Gadolinium