Dorsal Epidural Migration of a Disc Fragment at L2-L3 Level
Keywords:
epidural migration, extruded disc, cauda equina syndromeAbstract
Introduction: Extruded disc fragments that migrated to the dorsal epidural region are atypical events because the arrangement of the anatomical structures does not usually allow their migration. Its clinical presentation corresponding with lumbar sciatica or as part of symptoms related to cauda equina syndrome. Sometimes the diagnosis is only possible during surgery or histopathological study. The treatment of choice is the removal of the extruded fragments with decompression of the neurological structures.
Objective: To describe the diagnosis and surgical treatment of a patient with dorsal epidural migration of the disc fragment at the lumbar level.
Clinical case report: The case of a 63-year-old male patient who came the neurology consultation is reported. He referred that in August 2022 he began with great intensity and lancinating pain in the lumbosacral region, radiating towards the buttocks. The subject did not notice relief with the use of analgesics or rest, he had difficulty urinating and constipation, which was not common for him. These symptoms continued and worsened over time, which eventually caused the impossibility of walking and standing, difficulty achieving an erection, and several episodes of acute urinary retention. It was decided to admit him to the neurology service and he underwent imaging studies, showing a posterior extradural intraspinal lesion, at L2-L3 level. The surgical procedure was performed in the neurosurgery service, with no trans surgical complications. The pathological study, with hematoxylin and eosin staining, revealed fragments of the yellow ligament and nucleus pulposus.
Conclusions: Posterior epidural migration of disc fragments is a rare presentation, requiring efficient diagnostic analysis and early surgical treatment to prevent neurological deterioration and to obtain favorable results, since it can cause disability from lumbar sciatica to cauda equine syndrome. Therefore, it represents a surgical emergency.Downloads
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