Kiyoshi Tarukado1, Ko Ikuta2, Yoshiaki Fukutoku2, Osamu Tono3, Toshio Doi3. 1. Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga 874-8588, Japan; Department of Orthopedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Tsurumi Beppu, Oita 874-0838, Japan. Electronic address: kt99059@hotmail.com. 2. Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga 874-8588, Japan. 3. Department of Orthopedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Tsurumi Beppu, Oita 874-0838, Japan.
Abstract
BACKGROUND CONTEXT: Posterior epidural migrated lumbar disc fragments is an extremely rare disorder. Surgical treatment was performed in all reported cases. To the best of our knowledge, there are no reported cases of the use of conservative treatment for posterior epidural migrated lumbar disc fragments. PURPOSE: To report the possibility of a spontaneous regression of posterior epidural migrated lumbar disc fragments. STUDY DESIGN: Case series. METHODS: Four patients with posterior epidural migrated lumbar disc fragments were treated at Karatsu Red Cross Hospital between April 2008 and August 2010. Spontaneous regression of the posterior epidural migrated lumbar disc fragments with relief of symptoms was observed on magnetic resonance imaging (MRI) in three cases. Another patient underwent surgical treatment. The present and previously reported cases of posterior epidural migrated lumbar disc fragments were analyzed with respect to patient age, imaging features on MRI, the level of the lesion, clinical symptoms, treatment, and outcomes. RESULTS: Conservative treatment was successful, and spontaneous lesion regression was seen on MRI with symptom relief in three cases. CONCLUSIONS: Although posterior epidural migrated lumbar disc fragment cases are generally treated surgically, the condition can regress spontaneously over time, as do sequestrated disc fragments. Spontaneous regression of lumbar disc herniations is a widely accepted observation at present. Posterior epidural migrated lumbar disc fragments fall under the sequestrated type of disc herniation. In fact, the course of treatment for posterior epidural migrated lumbar disc fragments should be determined based on the symptoms and examination findings, as in cases of ordinary herniation. However, providing early surgical treatment is important if the patient has acute cauda equina syndrome or the neurologic symptoms worsen over time.
BACKGROUND CONTEXT: Posterior epidural migrated lumbar disc fragments is an extremely rare disorder. Surgical treatment was performed in all reported cases. To the best of our knowledge, there are no reported cases of the use of conservative treatment for posterior epidural migrated lumbar disc fragments. PURPOSE: To report the possibility of a spontaneous regression of posterior epidural migrated lumbar disc fragments. STUDY DESIGN: Case series. METHODS: Four patients with posterior epidural migrated lumbar disc fragments were treated at Karatsu Red Cross Hospital between April 2008 and August 2010. Spontaneous regression of the posterior epidural migrated lumbar disc fragments with relief of symptoms was observed on magnetic resonance imaging (MRI) in three cases. Another patient underwent surgical treatment. The present and previously reported cases of posterior epidural migrated lumbar disc fragments were analyzed with respect to patient age, imaging features on MRI, the level of the lesion, clinical symptoms, treatment, and outcomes. RESULTS: Conservative treatment was successful, and spontaneous lesion regression was seen on MRI with symptom relief in three cases. CONCLUSIONS: Although posterior epidural migrated lumbar disc fragment cases are generally treated surgically, the condition can regress spontaneously over time, as do sequestrated disc fragments. Spontaneous regression of lumbar disc herniations is a widely accepted observation at present. Posterior epidural migrated lumbar disc fragments fall under the sequestrated type of disc herniation. In fact, the course of treatment for posterior epidural migrated lumbar disc fragments should be determined based on the symptoms and examination findings, as in cases of ordinary herniation. However, providing early surgical treatment is important if the patient has acute cauda equina syndrome or the neurologic symptoms worsen over time.
Authors: Antonio Montalvo Afonso; Olga Mateo Sierra; Oscar Lucas Gil de Sagredo Del Corral; Antonio José Vargas López; Lain Hermes González-Quarante; Emma Sola Vendrell; Julia Romero Martínez Journal: Spinal Cord Ser Cases Date: 2018-07-06