Park Taejune, Lee Ho Jun, Kim Jae Seong, Nam Kiyeun
Departments of Physical Medicine and Rehabilitation, College of Medicine, Dongguk University, Gyeonggi-do, Korea.
Department of Emergency Medicine, College of Medicine, Dongguk University, Gyeonggi-do, Korea.
J Back Musculoskelet Rehabil. 2018;31(4):685-691. doi: 10.3233/BMR-170866.
Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors.
Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report.
We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment.
We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%.
As posterior epidural lumbar disc fragment could be masqueraded as spinal tumor, if rim enhancement is observed in MRI scans with sudden symptoms of radiculopathy or cauda equina syndrome, it should be taken into consideration. Early diagnosis can lead to early surgery, which can reduce complications.
由于解剖学屏障，腰椎间盘后突碎片并不常见，且由于其发病率低和放射学评估的模糊性，腰椎间盘后突碎片难以诊断。此外，它很难与脊髓肿瘤等其他疾病相鉴别。
腰椎间盘后突碎片的鉴别诊断在临床上很重要，因为其诊断会影响治疗和预后。为了研究腰椎间盘后突碎片的发病率、解剖学关注点、病因、症状、诊断工具、治疗和预后，我们回顾了包括病例报告在内的文章。
我们检索了迄今为止发表的所有关于腰椎间盘后突碎片的临床研究。检索了以下关键词：腰椎间盘后突碎片、椎间盘移位、后位硬膜外椎间盘、硬膜外移位、背侧硬膜外移位、游离椎间盘和椎间盘碎片。
我们从28项研究中确定了40例腰椎间盘后突碎片患者。腰椎间盘后突碎片最常见的表现是突发神经根病（70.0%），其次是马尾综合征（27.5%）。最常用的诊断方法是磁共振成像（MRI），共36例（90.0%），其次是计算机断层扫描，共14例（35.0%）。影像学检查后，术前诊断为肿块的占45.0%，病变的占20.0%，肿瘤的占12.5%。腰椎间盘后突碎片的特征性MRI表现有助于诊断；相对于母椎间盘，它在T1加权图像上通常显示低信号，在T2加权图像上显示高信号。此外，大多数椎间盘碎片在注射钆剂后的MRI上显示周边环形强化。电诊断测试有助于证实神经损伤。所有病例均进行了手术治疗，观察到神经并发症的发生率为12.5%。
由于腰椎间盘后突碎片可能被伪装成脊髓肿瘤，如果在MRI扫描中观察到边缘强化且伴有突发神经根病或马尾综合征症状，应予以考虑。早期诊断可导致早期手术，从而减少并发症。
