Extraforaminal lumbar herniated disc mimicking foraminal tumor: Case report, literature review, and the role for minimally invasive approach for resection

Abstract

Herniated discs in the lumbar spine are common, however, extraforaminal disc herniations are less frequently encountered. Occasionally, rare disc herniations can mimic other pathologies such as nerve tumor. We present such case and a review of similar cases in the scientific literature. A 71-year-old male who presented with back pain and right-side sciatic pain. Magnetic resonance imaging revealed a fusiform enhancing 3 cm × 2 cm lesion that was concerning for a nerve sheath tumor. A minimally invasive lateral trans-psoas approach was performed for a biopsy that revealed disc fragments and a full resection was performed. The patient's symptoms improved at follow-up. Although uncommon, extraforaminal disc herniations can be mistaken for peripheral nerve tumors on imaging. The spine surgeon should remain vigilant about these entities and plan the surgical treatment accordingly.

Keywords

• herniated disc
• lumbar radiculopathy
• minimally invasive surgery
• nerve sheath tumor
• trans-psoas approach