Posteriorly migrated epidural lumbar disc extrusion with contralateral neurodeficit: An unusual presentation

Abstract

The posterior epidural migration of lumbar disc herniation is a rare condition, and the overall reported incidence is 0.4%–1.04%. Most of these cases present with cauda equina syndrome or polyradiculopathy on ipsilateral side. We report a case of posterior epidural migration of lumbar disc causing contralateral neurodeficit. A 66-year-old gentleman presented with axial pain radiating to the left anterolateral thigh since 15 days after heavy weight lifting. Neurological examination revealed hypoesthesia over left L3 dermatome and left knee extensor weakness (Medical Research Council grade 3/5). Magnetic resonance imaging with contrast showed L2–L3 right-side extruded disc fragment migrated posteriorly in epidural space. Contralateral monoradiculopathy was an unusual presentation. Interlaminar decompression and discectomy were able to achieve complete neurological recovery at three months. To the best of our knowledge, this is the second case with contralateral neurodeficit due to posteriorly migrated lumbar disc herniation.

Keywords

• cauda equina
• polyradiculopathy
• posterior epidural lumbar disc