Kutty Raja K, Sunilkumar Balakrishnan Sreemathyamma, Peethambaran Anilkumar, Jain Sourabh Kumar, Kumar Shailesh
Department of Neurosurgery, Government Medical College, Thiruvananthapuram, India.
J Spine Surg. 2017 Sep;3(3):498-503. doi: 10.21037/jss.2017.08.07.
Intervertebral disc prolapse is a common cause of both acute and chronic low back pain. This can result in differential grades of motor and sensory disturbances in lower limbs and even cauda equina syndrome (CES). The neurological manifestations are a result of compression of the spinal cord and roots ventrally in the spinal canal due to the prolapsed disc. However, neurologic deficits owing to compression of the spinal cord dorsally as a result of migration of sequestrated disc fragments are very rare. We present two different cases of back pain with severe neurologic deficit referred to us within a short span of one month. Among them, one had long standing history of back pain while other had none. Both patients were investigated and found to have a sequestrated disc fragment which had dorsally migrated to the epidural space and was causing severe compression of the spinal cord. They underwent laminectomy and removal of the sequestrated fragment. However, they were only partially relieved of their motor and bladder weakness. We present our cases to highlight this rare form of lumbar epidural intervertebral disc migration, as well as enumerate the diagnostic challenges and discuss the differential diagnosis and treatment.
椎间盘突出是急慢性下腰痛的常见原因。这可导致下肢不同程度的运动和感觉障碍，甚至马尾综合征（CES）。神经学表现是由于突出的椎间盘在椎管内腹侧压迫脊髓和神经根所致。然而，由于游离椎间盘碎片移位导致脊髓背侧受压引起的神经功能缺损非常罕见。我们报告了两例在短短一个月内转诊至我们这里的伴有严重神经功能缺损的背痛病例。其中一例有长期背痛病史，而另一例没有。对两名患者进行检查后发现，他们都有一个游离的椎间盘碎片，该碎片已背侧移位至硬膜外间隙并导致脊髓严重受压。他们接受了椎板切除术并取出了游离碎片。然而，他们的运动和膀胱无力症状仅得到部分缓解。我们展示我们的病例以突出这种罕见的腰椎硬膜外椎间盘移位形式，列举诊断挑战并讨论鉴别诊断和治疗方法。
