Teufack Sonia G, Singh Harminder, Harrop James, Ratliff John
Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
J Spinal Cord Med. 2010;33(3):268-71. doi: 10.1080/10790268.2010.11689706.
BACKGROUND/OBJECTIVE: Intervertebral disk herniation is relatively common. Migration usually occurs in the ventral epidural space; rarely, disks migrate to the dorsal epidural space due to the natural anatomical barriers of the thecal sac.
Case report.
A 49-year-old man presented with 1 week of severe back pain with bilateral radiculopathy to the lateral aspect of his lower extremities and weakness of the ankle dorsiflexors and toe extensors. Lumbar spine magnetic resonance imaging with gadolinium revealed a peripheral enhancing dorsal epidural lesion with severe compression of the thecal sac. Initial differential diagnosis included spontaneous hematoma, synovial cyst, and epidural abscess. Posterior lumbar decompression was performed; intraoperatively, the lesion was identified as a large herniated disk fragment.
Dorsal migration of a herniated intervertebral disk is rare and may be difficult to definitively diagnose preoperatively. Dorsal disk migration may present in a variety of clinical scenarios and, as in this case, may mimic other epidural lesions on magnetic resonance imaging.
背景/目的：椎间盘突出相对常见。移位通常发生在腹侧硬膜外间隙；由于硬脊膜囊的自然解剖屏障，椎间盘很少会移位至背侧硬膜外间隙。
病例报告。
一名49岁男性，出现严重背痛1周，伴有双侧下肢外侧神经根病，以及踝背屈肌和趾伸肌无力。腰椎磁共振成像钆增强显示一个外周强化的背侧硬膜外病变，硬脊膜囊严重受压。初步鉴别诊断包括自发性血肿、滑膜囊肿和硬膜外脓肿。进行了后路腰椎减压；术中，该病变被确定为一个巨大突出的椎间盘碎片。
椎间盘背侧移位罕见，术前可能难以明确诊断。背侧椎间盘移位可能在多种临床情况下出现，如本病例所示，在磁共振成像上可能类似其他硬膜外病变。
