Jae-Won Jang1, Jung-Kil Lee, Bo-Ra Seo, Soo-Han Kim. 1. Department of Neurosurgery, Chonnam National University Medical School and Research Institute of Medical Sciences, Dong-gu, Gwangju, Korea.
Abstract
STUDY DESIGN: Case description. OBJECTIVES: To describe a rare case of traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture and review the pertinent medical literature. SUMMARY OF BACKGROUND DATA: Intradural lumbar disc rupture is an uncommon and serious complication, particularly if it develops as an acute traumatic lesion. It can result in serious neurologic deficit if it is not treated in a timely and appropriate manner. METHODS: A 51-year-old man presented with motor paraparesis (grade 2/5) and hypeesthesia at left L1 and L2 sensory dermatome after a traffic collision. Computed tomography scan revealed a compression fracture of the L1 body. Lumbar magnetic resonance imaging demonstrated an intradural mass-like lesion behind the L2 body and deviation of the cauda equina by this lesion. An emergency L2 laminectomy was performed for removal of intradural space occupying lesion and decompression of cauda equina. The mass lesion was removed in 1 piece, and other space occupying lesions were not found in the spinal canal. RESULTS: Pathologic examination for intradural mass lesion demonstrated fibrocartilage such as disc material. After the operation, the patient's neurologic symptoms showed gradual improvement, and by postoperative day 18, he had made a full recovery. At his 1-year follow-up examination, the patient was completely independent and free from any neurologic deficits. CONCLUSION: We report a rare case of traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention resulted in a good functional outcome. Lumbar disc rupture into the dural sac should be added to the differential diagnosis of acute traumatic spinal lesion causing spinal cord or cauda equina compression.
STUDY DESIGN: Case description. OBJECTIVES: To describe a rare case of traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture and review the pertinent medical literature. SUMMARY OF BACKGROUND DATA: Intradural lumbar disc rupture is an uncommon and serious complication, particularly if it develops as an acute traumatic lesion. It can result in serious neurologic deficit if it is not treated in a timely and appropriate manner. METHODS: A 51-year-old man presented with motor paraparesis (grade 2/5) and hypeesthesia at left L1 and L2 sensory dermatome after a traffic collision. Computed tomography scan revealed a compression fracture of the L1 body. Lumbar magnetic resonance imaging demonstrated an intradural mass-like lesion behind the L2 body and deviation of the cauda equina by this lesion. An emergency L2 laminectomy was performed for removal of intradural space occupying lesion and decompression of cauda equina. The mass lesion was removed in 1 piece, and other space occupying lesions were not found in the spinal canal. RESULTS: Pathologic examination for intradural mass lesion demonstrated fibrocartilage such as disc material. After the operation, the patient's neurologic symptoms showed gradual improvement, and by postoperative day 18, he had made a full recovery. At his 1-year follow-up examination, the patient was completely independent and free from any neurologic deficits. CONCLUSION: We report a rare case of traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention resulted in a good functional outcome. Lumbar disc rupture into the dural sac should be added to the differential diagnosis of acute traumatic spinal lesion causing spinal cord or cauda equina compression.