Mallepally Abhinandan Reddy, Gantaguru Amrit, Marathe Nandan, Meena Sanjay Kumar, Tandon Vikas
Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.
Asian J Neurosurg. 2020 Aug 28;15(3):674-677. doi: 10.4103/ajns.AJNS_79_20. eCollection 2020 Jul-Sep.
About 35%-72% of lumbar disc herniations are associated with fragment migration. However, the posterior epidural migration is rare. We present a strange situation encountered during surgical decompression of the posterior migrated fragment. A 72-year-old male presented with a history of pain radiating to the left lower limb and Grade 3 power of the extensor hallucis longus. Magnetic resonance imaging revealed a prolapsed intervertebral disc and a possible posterior epidural migration of disc fragment. Routine surgical steps for microdiscectomy were followed after confirmation of level using fluoroscopy. However, the extruded disc fragment was not seen, and both exiting and traversing roots were free with adequate mobility. After extensively searching for a disc in the spinal canal, suction fluid was filtered through a surgical mop used as a sieve. Material collected was sent for histopathological study. Biopsy report confirmed material filtered was indeed the intervertebral disc. Thus, accidental suction of disc material in case of the posterior epidural migrated disc is a possibility, and we should be vigilant about this scenario to avoid disaster.
约35%-72%的腰椎间盘突出症与碎片移位有关。然而，硬膜外后移很少见。我们报告了一例在手术减压后移碎片过程中遇到的奇怪情况。一名72岁男性，有左下肢放射性疼痛病史，拇长伸肌肌力3级。磁共振成像显示椎间盘突出，且椎间盘碎片可能有硬膜外后移。在通过荧光透视确认节段后，按照显微椎间盘切除术的常规手术步骤进行操作。然而，未见到挤出的椎间盘碎片，穿出和走行的神经根均无受压且活动度良好。在椎管内广泛寻找椎间盘后，将吸引液通过用作筛子的手术拖把进行过滤。收集的材料送去做组织病理学研究。活检报告证实过滤出的材料确实是椎间盘。因此，对于硬膜外后移的椎间盘，有可能意外吸出椎间盘物质，我们应对此情况保持警惕以避免灾难。
