Sequestered lumbar disc herniation mimicking spinal tumor

AbstractThe occurrence of herniated disc simulating diseases in neuroimaging it's an uncommon situation. However, due to changes that occur in sequestered disc fragment, some cases can mimic spinal neoplasms. Thus, we present the case of a female patient, 60 year-old, with left back pain and left leg weakness. Left lower limb presented with strength grade IV, positive 45 degress Lasègue's signal and patellar areflexia. Lumbar spine magnetic resonance imaging (MRI) showed an expansive left centro-lateral lesion at L4-L5 level, hypointense on T1W, hyperintense on T2W, with peripheral contrast uptake, causing compression of the dural sac and L5 nerve root. A hemilaminectomy was performed, with complete excision of the lesion. Histological analisys confirmed discal hernia. Disc herniation is a condition characterized by the displacement of the disc content to the spinal canal, predominantly in the lumbar region, and manifesting as radiculopathy. The fragment sequestration occurs in 30% of the cases and is characterized by loss of continuity with remaining disc. MRI exams generally allow diagnostic confirmation; however, there may be diagnostic confusion with tumors, arachnoid cysts and abscesses. The inflammatory reaction occurred in the disc fragment produces the differences in MRI signal. The fragment is hypointense on T1W, hyperintense on T2W, with peripheral enhancement after contrast. Malignancies and Schwannomas have homogeneous or heterogeneous uptake. The epidural abscess is isointense on T1W and hyperintense on T2W, with homogeneous or peripheral enhancement, similar to discal herniation. Thus, sequestered disc herniation can mimic other space-occupying lesions, being necessary a surgical approach to obtain material for histopathological analysis and diagnostic confirmation.

Download Full-text

Comparison of Myelography and Computed Tomography in Establishing Lumbar Disc Herniation

Acta Radiologica ◽

10.1177/028418518903000303 ◽

1989 ◽

Vol 30 (3) ◽

pp. 241-246 ◽

Cited By ~ 3

Author(s):

M. K. J. Fagerlund ◽

U. E. Thelander

Keyword(s):

Computed Tomography ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Soft Tissues ◽

Lumbar Disc ◽

False Negative ◽

Herniated Disc ◽

Intervertebral Disc Herniation ◽

Lumbar Region ◽

Negative Case

The results of lumbar myelography and computed tomography (CT) were compared in 51 consecutive patients with clinically suggested lumbar disc herniation. A total of 100 intervertebral levels were examined. At 62 levels, either L4/L5 or L5/S1, myelography was normal. CT showed no pathologic changes at 55 levels. The results concurred between myelography and CT in 89 per cent of the patients with normal findings. Four cases of disc herniation and one bulging disc, which had been missed at myelography because of a large epidural space at L5/S1, were picked up by CT. Two of these were verified by surgery and two were treated conservatively. There was one possible false negative case with CT as well. Abnormalities were shown at 38 intervertebral levels, 22 in the bulging and 16 in the herniated disc group. The pathologic changes concurred in 84 per cent between the two investigations. For intervertebral disc herniation the true negative rate was, for myelography 88 per cent and for CT 97 per cent. The treatment strategy could have been based on CT alone at 37 out of 38 levels (97%), and on myelography alone at 34 out of 38 levels (89%). Furthermore, at CT the imaging of soft tissues and intervertebral joints was superior to that at myelography. It is concluded that CT should be the primary examination method of imaging for lumbar disc herniation. Myelography is, however, to be preferred where the level of the lesion is clinically unclear or when the entire lumbar region and thoraco-lumbar junction are to be examined.

Download Full-text

Genotypic and Antimicrobial Characterisation ofPropionibacterium acnesIsolates from Surgically Excised Lumbar Disc Herniations

BioMed Research International ◽

10.1155/2013/530382 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 37

Author(s):

Jess Rollason ◽

Andrew McDowell ◽

Hanne B. Albert ◽

Emma Barnard ◽

Tony Worthington ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Herniated Disc ◽

Type Ii ◽

Type Ia ◽

Disc Herniations ◽

Typing Methods ◽

Human Infections ◽

Clinical Conditions

The anaerobic skin commensalPropionibacterium acnesis an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation.P. acnesand other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence ofP. acnesin their excised herniated disc tissue. UsingrecAand mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role ofP. acnesin lumbar disc herniation should not be readily dismissed.

Download Full-text

Unilateral facetectomy approach for lateral lumbar disc herniation

Journal of Neurosurgery ◽

10.3171/jns.1991.74.5.0754 ◽

1991 ◽

Vol 74 (5) ◽

pp. 754-756 ◽

Cited By ~ 75

Author(s):

Eddy Garrido ◽

P. Noel Connaughton

Keyword(s):

Disc Herniation ◽

Lumbar Fusion ◽

Lumbar Disc ◽

Herniated Disc ◽

Spinal Instability ◽

Content Type ◽

X Ray ◽

Flexion And Extension ◽

Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

Download Full-text

Disappearing cervical disc

Neurosurgical FOCUS ◽

10.3171/foc.1996.1.6.5 ◽

1996 ◽

Vol 1 (6) ◽

pp. E4 ◽

Cited By ~ 1

Author(s):

Richard M. Westmark ◽

Kaye D. Westmark ◽

Volker K. H. Sonntag

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Computerized Tomography ◽

Disc Herniation ◽

Lumbar Disc ◽

Spontaneous Resolution ◽

Herniated Disc ◽

Cervical Disc ◽

Resonance Imaging ◽

Herniated Lumbar Disc

The authors report the case of a 48-year-old woman who experienced spontaneous resolution of a large herniated disc at C6-7. Spontaneous resolution of a herniated lumbar disc was first documented by computerized tomography. This case is another example of a rare spontaneous resolution of a cervical disc herniation documented by magnetic resonance imaging.

Download Full-text

Correlazione RM-istopatologica del potenziamento periferico delle ernie discali

Rivista di Neuroradiologia ◽

10.1177/19714009970100s295 ◽

1997 ◽

Vol 10 (2_suppl) ◽

pp. 213-214 ◽

Cited By ~ 1

Author(s):

I. Aprile ◽

S. Pizzolitto ◽

F. De Nardi ◽

P. Del Fabro ◽

F. Iaiza ◽

...

Keyword(s):

Magnetic Resonance ◽

Histological Examination ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Granulation Tissue ◽

Lumbar Disc ◽

Peripheral Enhancement

We found ring enhancement in 10 patients with lumbar disc herniation examined with magnetic resonance. In 5 cases histological examination showed peri-discal granulation tissue. The peripheral enhancement found in some cases of disc herniation is caused by inflammatory granulation tissue.

Download Full-text

Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation: Consideration of the Relation between the Iliac Crest and L5-S1 Disc

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.e301 ◽

2016 ◽

Vol 19 (2;2) ◽

pp. E301-E308

Author(s):

Kyung-Chul Choi

Keyword(s):

Disc Herniation ◽

Iliac Crest ◽

Facet Joint ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Leg Pain ◽

Herniated Disc ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Endoscopic Lumbar Discectomy ◽

Foraminal Height

Background: Percutaneous transforaminal techniques for the treatment of lumbar disc herniation have markedly evolved. Percutaneous endoscopic lumbar discectomy (PELD) for L5-S1 disc herniation is regarded as challenging due to the unique anatomy of the iliac crest, large facet joint, and inclinatory disc space. Among these, the iliac crest is considered a major obstacle. There are no studies regarding the height of the iliac crest and their appropriate procedures in PELD. Objectives: This study discusses PELD for L5-S1 disc herniation and the appropriate approach according to the height of iliac crest. Study Design: Retrospective evaluation. Methods: 100 consecutive patients underwent PELD via the transforaminal route for L5-S1 disc herniation by a single surgeon. The study was divided into 2 groups: the foraminoplasty group requiring foraminal widening to access the herniated disc and the non-foraminoplasty group treated by conventional posterolateral access. Radiological parameters such as iliac height, the relative position of the iliac crest to the landmarks of the L5-S1 level, iliosacral angle and foraminal height, and disc location were considered. Clinical outcomes were assessed by the Visual Analogue Scale (VAS, 0 – 10) for back and leg pain, the Oswestry Disability Index (ODI, 0 – 100%), and the modified MacNab criteria. Results: The overall VAS scores for back and leg pain decreased from 6.0 to 2.3 and from 7.5 to 1.7. The mean ODI (%) improved from 54.0 to 11.6. Using modified MacNab criteria, a good outcome was 92%. Foraminoplasty was required in 19 patients. Iliac crest height was significantly higher in the foraminoplasty group than the non-foraminoplasty group (37.7 mm vs 30.1 mm, P < 0.001). In the foraminoplasty group, the iliac crest is above the mid L5 pedicle on lateral radiography in all cases. There were no significant differences in foraminal height, foraminal width, iliosacral angle, or disc height between the 2 groups. In addition, there were no differences in clinical outcome between the 2 groups. Limitations: This study is a retrospective analysis and simplifies the complexity of the L5-S1 level and iliac bone using two-dimensional radiography. Conclusion: In high iliac crest cases where the iliac crest is above the mid L5 pedicle in lateral radiography, foraminoplasty may be considered for transforaminal access of L5-S1 disc herniation. Conventional transforaminal access can be utilized with ease in low iliac crest cases where the iliac crest is below the mid-L5 pedicle. Key words: Percutaneous endoscopic lumbar discectomy, transforaminal, L5-S1, iliac crest, foraminoplasty

Download Full-text

Analysis of Revision Surgery of Microsurgical Lumbar Discectomy

Asian Spine Journal ◽

10.4184/asj.2018.12.1.140 ◽

2018 ◽

Vol 12 (1) ◽

pp. 140-146 ◽

Cited By ~ 3

Author(s):

Taku Inada ◽

Sei Nishida ◽

Taigo Kawaoka ◽

Toshiyuki Takahashi ◽

Junya Hanakita

Keyword(s):

Disc Herniation ◽

Revision Surgery ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Herniated Disc ◽

Pathological Changes ◽

Video Footage ◽

Primary Surgery ◽

Surgery Group ◽

Significant Difference

<sec><title>Study Design</title>A retrospective study.</sec><sec><title>Purpose</title>Our objectives were to determine the association between the pathological changes of disc herniation and the interval between primary and revision surgeries and to investigate the frequency and site of the dural laceration in the primary and revision surgeries.</sec><sec><title>Overview of Literature</title>Among 382 patients who underwent microsurgical lumbar discectomy, we investigated 29 who underwent revision surgery to analyze recurrent herniation pathologies and complications to determine the manner in which lumbar disc herniation can be more efficiently managed.</sec><sec><title>Methods</title>Of 29 patients, 22 had recurrent disc herniation at the same level and site. The pathological changes associated with compression factors were classified into the following two types depending on intraoperative findings: (1) true recurrence and (2) minor recurrence with peridural fibrosis (>4 mm thickness). The sites of dural laceration were examined using video footage and operative records.</sec><sec><title>Results</title>The pathological findings and days between the primary and revision surgeries showed no statistical difference (<italic>p</italic>=0.14). Analysis of multiple factors, revealed no significant difference between the primary and revision surgery groups with regard to hospital days (<italic>p</italic>=0.23), blood loss (<italic>p</italic>=0.99), and operative time (<italic>p</italic>=0.67). Dural lacerations obviously increased in the revision surgery group (1.3% vs. 16.7%, <italic>p</italic><0.01) and were mainly located near the herniated disc in the primary surgery group and near the root shoulder in the revision surgery group, where severe fibrosis and adhesion were confirmed. To avoid dural laceration during revision surgery, meticulous decompressive manipulation must be performed around the root sleeve.</sec><sec><title>Conclusions</title>We recommend that meticulous epidural dissection around the scar formation must be performed during revision surgery to avoid complications.</sec>

Download Full-text

A Rare Case of Spinal Subdural Hematoma Complicating Minimally Invasive Lumbar Micro Discectomy and Decompression for Recurrent Lumbar Disc Herniation

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.04.03.02 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Failed Back Surgery Syndrome ◽

Neurological Deficits ◽

Unusual Complication ◽

Lumbar Region ◽

Failed Back Surgery ◽

Spinal Subdural Hematoma ◽

Recurrent Lumbar Disc Herniation

Spinal subdural hematomas is a very rare and unusual complication of spinal interventions. We present a case of subacute SSDH in the lumbar region of a 60 year-old woman following microdiscectomy for recurrent lumbar disc herniation. By presenting this rarely seen case of postoperative subacute SSDH, we want to bring attention to the possible postoperative complications like spinal hematomas in the differential diagnosis of failed back surgery syndrome in patients who do not respond to conservative treatment or develop neurological deficits and to the importance of radiological imaging in such cases.

Download Full-text

Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e133 ◽

2019 ◽

Vol 2 (22.2) ◽

pp. E133-E138

Author(s):

Chan Hong Park

Keyword(s):

Risk Factors ◽

Disc Herniation ◽

Smoking Status ◽

Lumbar Disc ◽

Early Recurrence ◽

Herniated Disc ◽

Endoscopic Recurrence ◽

Imaging Results ◽

Key Words Disc Herniation ◽

A Prospective Study

Background: Transforaminal endoscopic lumbar disc decompression (TELD) has emerged as a treatment alternative to open lumbar discectomy, but rates of herniated lumbar disc (HLD) recurrence after TELD are higher by comparison. Objectives: We conducted this study to identify factors correlating with early HLD recurrence after TELD. Study Design: Retrospective study. Setting: The Department of Anesthesiology and Pain Medicine, Neurosurgery at Spine Health Wooridul Hospital. Methods: As a retrospective review, we examined all patients undergoing TELD between 2012 and 2017, analyzing the following in terms of time to recurrence: age, gender, body mass index (BMI), comorbid conditions (diabetes mellitus [DM], hypertension [HTN]), smoking status, nature of disc herniation (central, paramedian, or foraminal), Modic changes, migration grade (rostral vs. caudal track + degree), herniated disc height (Dht) and base size (Dbase), and the presence of spondylolisthesis on magnetic resonance imaging. Results: During the 5-year study period, 1,900 patients underwent TELD procedures, resulting in 209 recurrences (11.0%). In 27 of these patients (12.9%), herniation recurred within 24 hours after surgery. Recurrences most often developed within 2-30 days (n = 76). The smaller the size of a herniated disc, the earlier it recurred. Recurrences were unrelated to gender, BMI, DM or HTN, smoking status, migration grade, nature (Dht or Dbase of herniated disc), or the presence of spondylolisthesis. Limitations: In addition to variables assessed herein, other clinical and radiologic parameters that may be important in recurrent disc herniation should be included. Furthermore, only univariate analyses were performed, making no adjustments for potential confounders, therefore, independent risk factors could not be assessed. A prospective study would likely generate more precise results, especially in terms of standardized sampling and data classification. Finally, multiple causes for primary discectomy failures may have rendered our patient groups nonhomogeneous, and inequalities in surgical options or physician-dictated surgical choices may have had an effect. Conclusions: In patients undergoing TELD procedures, smaller-sized herniated discs are linked to early recurrences. Key words: Disc herniation, lumbar, endoscopic, recurrence, early

Download Full-text

EVALUATION OF THE EFFECTS OF ELECTRONIC ACUPUNCTURE COMBINED WITH “THAN THONG TRUC U THANG” REMEDY IN THE TREATMENT OF SCIATICA DUE TO LUMBAR DISC HERNIATION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.4.2 ◽

2019 ◽

pp. 15-21

Author(s):

Van Hung Nguyen ◽

Truc Quynh Nguyen ◽

Thi Tan Nguyen

Keyword(s):

Traditional Medicine ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Modern Medicine ◽

Herniated Disc ◽

Good Level ◽

Before And After ◽

A Prospective Study

Background: Sciatica due to lumbar disc herniation is one of the most common diseases in the world as well as in Viet Nam, sciatica impact on patient’s quality of life, ability to work and social interaction. Currently there are many methods of treatment with modern medicine and traditional medicine. Objectives: To investigate some clinical and paraclinical characteristics of sciatica due to herniated disc without surgery and to evaluate the effects of electronic acupuncture combined of with “Than thong truc u thang” remedy in the treatment of sciatica due to lumbar disc herniation. Methods: The sample is 27 patients diagnosed sciatica due to lumbar disc herniation. We examined and treated at Traditional Medicine Department of Hue Central Hospital. A prospective study, assess the results before and after the treatment. Results: Good level occupied 44.4%; fair good level occupied 37.0%; averge good level occupied 18.5%. Conclusion: This combination is effective treatment for sciatica due to lumbar disc herniation. Key words: Sciatica, lumbar disc herniation, electronic – acupuncture, “Than thong truc u thang” remedy

Download Full-text