Department of Surgery, Sin-Lau Hospital, Tainan, Taiwan.
Neurosurgery. 2011 Nov;69(5):E1148-51. doi: 10.1227/NEU.0b013e3182245b21.
Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment.
A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesys flexible rod system at L3-S1 for multisegment degenerative disc disease. The lesion proved to be an epidural disc fragment with sequestration into bilateral facet joints.
A free disc fragment should be considered in the differential diagnosis of posterior epidural lesions, and even in the facet joint.
症状性腰椎间盘突出症很常见。游离椎间盘碎片的迁移通常发生在颅侧、尾侧或外侧方向。硬膜外后迁移非常罕见。我们报告首例游离椎间盘碎片向后硬膜外迁移并嵌顿到双侧小关节的病例。
一名 78 岁女性出现腰痛和右腿疼痛。平片显示腰椎滑脱。磁共振成像显示硬膜外肿块和小关节内肿块，T1 加权图像呈低信号，T2 加权图像呈高信号。左 L3-4 小关节内病变有边缘强化，而右病变在钆注射后无对比。术前鉴别诊断包括脓肿、肿瘤、血肿或滑膜囊肿。为腰椎滑脱行 L3-4 和 L4-5 椎间融合，并采用 Dynesys 弹性棒系统在 L3-S1 进行多节段退行性椎间盘疾病的混合技术。病变证实为硬膜外椎间盘碎片，嵌顿到双侧小关节。
游离椎间盘碎片应在硬膜外病变的鉴别诊断中考虑，甚至在小关节中也应考虑。
