Posterior epidural migration of herniated lumbar disc fragment

2011 ◽  
Vol 14 (3) ◽  
pp. 313-317 ◽  
Author(s):  
Ahmet Sengoz ◽  
Kadir Kotil ◽  
Erol Tasdemiroglu
Keyword(s):  
Surgical Treatment ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Case Series ◽  
Rare Condition ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Duration Of Symptoms ◽  
First Choice

Object Posterior epidural migration of a free disc fragment in the lumbar region is a very rare condition that has only been reported in isolated cases to date. Patients with this condition present with radiculopathy or major neurological deficits. Difficulties in diagnosis and the choice and timing of surgical treatment are important in these cases. In this clinical case series, features of cases with posterior epidural migration of free lumbar disc fragments accompanied by cauda equina syndrome are discussed. Methods Eight cases (0.27%) of posterior epidural migration of disc fragments were detected among 2880 patients surgically treated for lumbar disc herniation between 1995 and 2008. Seven of these patients had cauda equina syndrome. The mean duration of symptoms in the 8 cases was 4.2 days (range 1–10 days). The group included 6 men and 2 women, with a mean age of 48 years (range 34–72 years). The sequestered disc fragments were at the L3–4 level in 6 patients (75%) and the L4–5 level in 2 (25%). Magnetic resonance imaging showed tumor-like ring contrast enhancement around sequestered fragments in 5 patients. The patients' motor, sensory, sexual, and urological functions were evaluated postoperatively, and modified Odom criteria and a visual analog scale were used in the assessment of postoperative outcomes. Results A microsurgical approach was used in all cases. Sequestrectomy with minimal hemilaminotomy and removal of the free segments were performed. The patients were followed up for a mean period of 28.5 months. Three patients (37.5%) had excellent results, 3 (37.5%) had good results, 1 patient (12.5%) had fair results, and only 1 patient had poor results according to the Odom criteria. The main factors affecting the long-term outcomes were the presence of cauda equina syndrome and the time period between onset of symptoms and surgery. Conclusions Patients with posterior migration of a disc fragment present with severe neurological deficits such as cauda equina syndrome. Because the radiological images of disc fragments may mimic those of other more common posterior epidural space–occupying lesions, definite diagnosis of posteriorly located disc fragments is difficult. All of these lesions can be completely removed with hemilaminotomy and sequestrectomy, and early surgical treatment is important as a first choice to prevent severe neurological deficits.

scholarly journals The role of surgical decompression of Cauda equina in lumbar disc herniation in recovery of bladder function

2004 ◽  
Vol 57 (7-8) ◽  
pp. 327-330 ◽  
Author(s):  
Danilo Radulovic ◽  
Goran Tasic ◽  
Milos Jokovic ◽  
Igor Nikolic
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Surgical Decompression ◽  
Bladder Function ◽  
Duration Of Symptoms ◽  
Significant Difference

INTRODUCTION Cauda equina syndrome from lumbar disc herniation accounts for up to 2-3% of all disc herniations. The aim of this study was to investigate whether recovery of bladder function after surgery depends on preoperative duration of disease. Patients and methods This retrospective study included 47 patients who underwent surgery for cauda equina syndrome due to a herniated disc in the period between 1997 and 2002. Eleven patients were female and 36 male, with a mean age of 43 years (range 23-67). All presented with sciatica and saddle hypoesthesia, whereas 13 presented with motor weakness of legs. All patients had been catheterized at the time of admission to the Neurosurgical unit. Levels of herniation were L4-L5 in 27 (57%), L5-S1 in 14 (30%), and L3-L4 in 6 (13%) patients. In 7 (15%) patients, surgery was performed within 48 hours of the cauda equina syndrome onset. None underwent surgery within 24 hours. 13 (28%) patients were operated between the 2nd and 7th day and 27 (57%) after 7th day of the cauda equina onset. The role of preoperative duration of symptoms in recovery of bladder function was examined (chi 2 analysis). RESULTS The follow-up ranged from 15 to 74 months (mean 24.2 months). In 33 patients (70%) excellent result were achieved, in 9 (19%) patients good results and 5 (11%) patients presented with poor results. There was no statistically significant difference concerning the time between the onset of symptoms and surgical decompression and subsequent recovery of bladder function (p>0.05). CONCLUSION After accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome due to lumbar disc herniation appear satisfactory regardless of the timing of surgery.

scholarly journals Spontaneous lumbo-sacral epidural hematoma presenting as Cauda Equina syndrome: a case report

2021 ◽  
Vol 9 (8) ◽  
pp. 2475
Author(s):  
Mohammad Sarwar ◽  
Laxminarayan Tripathy ◽  
Kalyanbrata Bhattacharyya
Keyword(s):  
Case Report ◽  
Cauda Equina Syndrome ◽  
Epidural Hematoma ◽  
Cauda Equina ◽  
Rare Condition ◽  
Surgical Decompression ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Recommended Treatment ◽  
Spinal Epidural

Spinal epidural hematoma (SEH) is a rare condition and it accounts for less than 1% of all spinal canal space occupying conditions. Spontaneous SEH most commonly occurs in the cervical and thoracic regions. They present with neck or back pain with radiculopathy and/ or myelopathy. Early surgical decompression is the recommended treatment in the presence of progressive neurological deficits. Spontaneous SEH (SSEH) presenting as Cauda Equina syndrome (CES) are rarely reported in the literature. We present a case of SSEH presenting late with CES. Due to delay in presentation and multiple co-morbidities, patient was treated conservatively.

scholarly journals Hemi-Cauda Equina Syndrome from Herniated Lumbar Disc: a Neurosurgical Emergency?

1996 ◽  
Vol 23 (4) ◽  
pp. 296-299 ◽  
Author(s):  
Ronald H.M.A. Bartels ◽  
Joost de Vries
Keyword(s):  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Leg Pain ◽  
Motor Deficit ◽  
Duration Of Symptoms ◽  
Radiographic Findings ◽  
Herniated Lumbar Disc ◽  
Symptoms And Signs

AbstractBackground: We report experience with patients presenting with a specific combination of symptoms: unilateral sciatica, unilateral sensibility loss in the dermatomes SI to S5 (hemi-saddle) and subjective micturation problems secondary to ruptured lumbar disc. Because of its similarities with a cauda equina syndrome, this combination of symptoms was thought to be a unilateral cauda equina syndrome and it was called hemi-cauda equina syndrome. Consequently, it was treated as an emergency. Methods: Ten patients were evaluated. They compromised 2.3% of all patients undergoing lumbar discectomy. Results: Outcome is good with only 10% persisting minor neurologic deficit (sensibility loss in dermatomes S3 to S5). With the exception of urinary retention or incontinence, duration of symptoms and signs does not seem to influence outcome. Comparing signs, symptoms and radiographic findings with those of a cauda equina syndrome which were recently and thoroughly studied, they were found to be more severe in cases of cauda equina syndrome. Especially, the good outcome, (apparently unrelated to the duration of symptoms in cases of hemi-cauda equina syndrome) contrasted with the treatment results of cauda equina syndrome. Conclusions: We defined the hemi-cauda equina syndrome from ruptured disc as a combination of unilateral leg pain, unilateral sensibility loss in dermatomes SI to S5 and sphincter paralysis (proven urinary retention or incontinence). Motor deficit is not necessarily present. Emergency surgery is warranted. Patients presenting with micturation complaints other than urinary retention or incontinence do not suffer from a hemi-cauda equina syndrome.

scholarly journals A Case Series of Acute Painless Bilateral Foot Drop Without Cauda Equina Syndrome

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Manoj Kumar ◽  
Nikhil Jain ◽  
Nitin Adsul ◽  
Shankar Acharya ◽  
R. S. Chahal ◽  
...  
Keyword(s):  
Early Intervention ◽  
Case Reports ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Neurological Recovery ◽  
Rare Presentation ◽  
Duration Of Symptoms ◽  
First Case

Introduction:Acute painless bilateral foot drop without bowel/bladder involvement is a very rare presentation of lumbar degenerative disorders. Only a few cases have been published on it in the literature. An early intervention could prove to be very helpful for the neurological recovery. Case Report:We present three cases where patients developed acute onset bilateral foot drop without radiculopathy and without bowel/bladder involvement. The first case was due to acute lumbar disc herniation, the second was caused by acute disc prolapse in a pre-existing asymptomatic lumbar canal stenosis, and the third one precipitated in a progressive degenerative severe lumbar spinal stenosis. Two cases (case reports 1 and 3) underwent minimal invasive decompression while the other case (case report 2) underwent instrumentation+ decompression + fusion. Case 1 and 2 with a short duration of symptoms showed good neurological recovery, whileereas cCase 3 with longer duration of complaints did not improve. Conclusion:Patients presenting with painless bilateral foot drop without cauda equine syndrome should be evaluated for spinal causes besides central nervous systemCNS, peripheral nerve, metabolic and autoimmune causes. Any finding in support of lumbar degenerative disease as the cause after excluding other causes should prompt for surgical decompression of the spine as an early intervention might help patient recover back to a normal and active lifestyle. Keywords:Painless, bilateral, foot drop, acute.

scholarly journals Acute bilateral foot drop with or without cauda equina syndrome—a case series

2021 ◽  
Vol 163 (4) ◽  
pp. 1191-1198
Author(s):  
Andreas K. Demetriades ◽  
Marco Mancuso-Marcello ◽  
Asfand Baig Mirza ◽  
Joseph Frantzias ◽  
David A. Bell ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Spinal Disease ◽  
Full Resolution ◽  
Degenerative Spinal Disease ◽  
The Mean ◽  
The One

Abstract Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.

Posterior epidural migration of sequestered lumbar disc fragments

1999 ◽  
Vol 90 (2) ◽  
pp. 264-266 ◽  
Author(s):  
Pierre Robe ◽  
Didier Martin ◽  
Jacques Lenelle ◽  
Achille Stevenaert
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Contrast Material ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Content Type ◽  
Diagnostic Pitfalls ◽  
Fine Print

✓ The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.

‘Scan-negative’ cauda equina syndrome: Evidence of functional disorder from a prospective case series

2015 ◽  
Vol 29 (2) ◽  
pp. 178-180 ◽  
Author(s):  
Ingrid Hoeritzauer ◽  
Carolynne M. Doherty ◽  
Stacey Thomson ◽  
Rachel Kee ◽  
Alan Carson ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Functional Disorder ◽  
Prospective Case Series

scholarly journals Outcome of Delayed Decompression Surgery for Cauda Equina Syndrome secondary to Lumbar Disc Herniation: A Case Report

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Lim SM ◽  
Johari J ◽  
Yusof MI
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Bowel Dysfunction ◽  
Decompression Surgery ◽  
Motor Weakness ◽  
Post Surgery ◽  
Maximum Improvement

Cauda equina syndrome (CES) is a constellation of symptoms which consist of low back pain, sciatica, saddlearea paraesthesia, urinary or faecal incontinence, with or without motor weakness, and sensory deficit. Surgical decompression is indicated as soon as possible, as decompression within 48 hours from onset allows maximum improvement of symptoms. Recovery usually occurs months or years postoperatively. We report a case of a patient with cauda equina syndrome secondary to massive lumbar disc herniation who had undergone urgent decompression one week after onset of urinary and bowel dysfunction. The clinical outcome post surgery was also discussed.

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