Posterior epidural migration of a lumbar disk: an entity not to ignore
Samia Frioui, Faycel Khachnaoui
The Pan African Medical Journal. 2018;29:59. doi:10.11604/pamj.2018.29.59.9492

Create an account  | Log in
CCS Congress 2018 CCS Congress
"Better health through knowledge sharing and information dissemination "

Images in medicine

Posterior epidural migration of a lumbar disk: an entity not to ignore

Cite this: The Pan African Medical Journal. 2018;29:59. doi:10.11604/pamj.2018.29.59.9492

Received: 30/03/2016 - Accepted: 22/08/2016 - Published: 22/01/2018

Key words: Lumbar disc herniation, disc migration, cauda equina syndrome, magnetic resonance imaging

© Samia Frioui et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/29/59/full

Corresponding author: Samia Frioui, Physical Medicine and Rehabilitation Department, Sahloul Hospital Sousse, Tunisia (soumaf1975@yahoo.fr)


Posterior epidural migration of a lumbar disk: an entity not to ignore

Samia Frioui1, &, Faycel Khachnaoui1

 

1Physical Medicine and Rehabilitation Department, Sahloul Hospital Sousse, Tunisia

 

 

&Corresponding author
Samia Frioui, Physical Medicine and Rehabilitation Department, Sahloul Hospital Sousse, Tunisia

 

 

Image in medicine    Down

Discal hernia with posterior epidural migration is exceptional. Its diagnosis is difficult and often takes the form of an intraspinal tumor lesion. It has a various clinical manifestations. The association of this entity to a cauda equina syndrome found as isolated cases which were reported in the literature. MRI with injection is the best diagnostic tool. We must always consider this diagnosis in front of a posterior epidural mass with a peripheral enhancement on the contrast-enhanced images. Emergency surgery is needed to prevent serious neurological deficits. We report the case of a 29-year old patient who presented an acute lumbo-sciatica associated with a deficit of both lower limbs and urinary incontinence after lifting a heavy load. Clinical examination revealed a motor deficit of the triceps surae and in the relievers of the foot rated 1 in bilateral sides, hypoesthesia at the anterolateral part of the two legs and the feet, weak or abolished tendon reflexes, anesthesia in the saddle, hypotonic anal sphincter and bladder distension. MRI of the lumbar spine showed a right lumbar discal hernia (L3-L4) excluded with right posterior epidural migration compressing the dural sheath. Surgical treatment was undertaken in emergency: a decompression and herniectomy were performed. A partial sensor-motor recovery was observed. After ten months, the patient still has had a distal deficit of both lower limbs, bladder sphincter disorders for which it is under self-intermittent catheterization.

 

 

Figure 1: A) lumbar MRI sagittal section: mass oval shape about 2 cm height with same signal as the intervertebral disc intra ductal, extra dural seat, posterior epidural at the height of L3L4 intervertebral disk compressing the dural sheath on the same floor; B) lumbar MRI axial section: mass oval shape with same signal as the intervertebral disc intra ductal, extra dural seat, posterior epidural at the height of L3L4 intervertebral disk compressing the dural sheath on the same floor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 29 (January - April 2018)

Article tools

This article authors

On Pubmed
On Google Scholar

Navigate this article

Rate this article

Altmetric

PAMJ is a member of the Committee on Publication Ethics
Next abstract

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2018 - Pan African Medical Journal. All rights reserved