title: Spontaneous regression of posterior epidural migrated lumbar disc fragments: case series.
abstract: BACKGROUND
  Posterior epidural migrated lumbar disc fragments is an extremely rare disorder. Surgical treatment was performed in all reported cases. To the best of our knowledge, there are no reported cases of the use of conservative treatment for posterior epidural migrated lumbar disc fragments.
  
  
  OBJECTIVE
  To report the possibility of a spontaneous regression of posterior epidural migrated lumbar disc fragments.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Four patients with posterior epidural migrated lumbar disc fragments were treated at Karatsu Red Cross Hospital between April 2008 and August 2010. Spontaneous regression of the posterior epidural migrated lumbar disc fragments with relief of symptoms was observed on magnetic resonance imaging (MRI) in three cases. Another patient underwent surgical treatment. The present and previously reported cases of posterior epidural migrated lumbar disc fragments were analyzed with respect to patient age, imaging features on MRI, the level of the lesion, clinical symptoms, treatment, and outcomes.
  
  
  RESULTS
  Conservative treatment was successful, and spontaneous lesion regression was seen on MRI with symptom relief in three cases.
  
  
  CONCLUSIONS
  Although posterior epidural migrated lumbar disc fragment cases are generally treated surgically, the condition can regress spontaneously over time, as do sequestrated disc fragments. Spontaneous regression of lumbar disc herniations is a widely accepted observation at present. Posterior epidural migrated lumbar disc fragments fall under the sequestrated type of disc herniation. In fact, the course of treatment for posterior epidural migrated lumbar disc fragments should be determined based on the symptoms and examination findings, as in cases of ordinary herniation. However, providing early surgical treatment is important if the patient has acute cauda equina syndrome or the neurologic symptoms worsen over time.
authors.affiliation: Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga 874-8588, Japan; Department of Orthopedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Tsurumi Beppu, Oita 874-0838, Japan. Electronic address: kt99059@hotmail.com.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Tarukado
authors.affiliation: Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga 874-8588, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Ikuta
authors.affiliation: Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga 874-8588, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Fukutoku
authors.affiliation: Department of Orthopedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Tsurumi Beppu, Oita 874-0838, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tono
authors.affiliation: Department of Orthopedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Tsurumi Beppu, Oita 874-0838, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Doi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004824:Epidural Space / Q000473:pathology*; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology* / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000473:pathology* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011128:Polyradiculopathy / Q000473:pathology*; D012075:Remission, Spontaneous
keywords: Conservative treatment; Posterior epidural migrated lumbar disc fragments; Spontaneous lesion regression