Turkish Neurosurgery 2017 , Vol 27 , Num 1
Posterior Epidural Migration of a Sequestered Lumbar Intervertebral Disc Fragment
Yahya TURAN1,Tevfik YILMAZ1,Cuneyt GOCMEZ1,Huseyin OZEVREN1,Serdar KEMALOGLU1,Memik TEKE2, Mustafa Akif SARIYILDIZ3,Adnan CEVIZ1,Cuneyt TEMIZ4
1Dicle University, School of Medicine, Department of Neurosurgery, Diyarbakır, Turkey
2Dicle University, School of Medicine, Department of Radiology, Diyarbakır, Turkey
3Dicle University, School of Medicine, Department of Physical Medicine and Rehabilitation, Diyarbakır, Turkey
4Celal Bayar University, School of Medicine, Department of Neurosurgery, Manisa, Turkey
DOI : 10.5137/1019-5149.JTN.14712-15.1 AIM: Posterior epidural migration of a sequestered lumbar intervertebral disc fragment (PEMSLIDF) is an extremely rare condition published so far only as case reports or small case series (ranging between 2 to 8 cases). Diagnosing this condition is often challenging and the diagnosis is usually made intraoperatively. The affected patients usually suffer cauda equina syndrome (CES). In the present study, we aimed to discuss the clinical and radiological findings, types and features of surgical therapies, and outcomes of 9 patients with PEMSLIDF.

MATERIAL and METHODS: This study included 9 (0.36%) patients with PEMSLIDF among 2470 patients who underwent lumbar disc hernia surgery between August 2002 and September 2012. The preoperative clinical and radiological properties of the patients were evaluated. The postoperative outcomes were assessed using neurological examination, radiological imaging, visual analog scale (VAS) and modified Odom criteria.

RESULTS: As far as we know, this study is the largest case series examining the characteristics of PEMSLIDF. Seven (77.8%) of our patients were male and 2 (22.2%) were female and they had a mean age of 49.5 years (range 28-70 years). The mean duration from symptom onset to hospital admission was 7.4 days. Seven patients had CES. All patients underwent sequestrectomy and discectomy via posterior microsurgery. The patient outcomes were evaluated by the Modified Odom criteria and the outcome was excellent in two (22.2%) patients, good in 4 (44.5%), fair in 2 (22.2%), and poor in 1 (11.1%).

CONCLUSION: The entire free fragment can usually be excised via the posterior microsurgery technique. Early surgical treatment is of great importance to prevent more serious neurological deficits. Keywords : Cauda equina syndrome, Sequestered intervertebral disc, Posterior epidural migration, Lumbar disc herniation, Spinal surgery