Dorsal Epidural Migration of Lumbar Disc Fragment Causing Cauda Equina Syndrome- A Case Report

Abstract

Several anatomic factors like midline septum, lateral peridural membrane and epidural fat prevent dorsal migration of disc fragment. Hence, dorsal epidural migration of lumbar disc has a rare occurrence. It has a propensity to present with cauda equina syndrome. Epidural disc fragments mimic benign masses and hence poses a diagnostic challenge. The prognosis is good compared to other types of disc prolapse when surgical decompression is done early. A 45-year-old male labourer presented with chronic lower back pain with recent onset of motor weakness in right lower limb and bladder disturbance. Magnetic Resonance Imaging (MRI) showed a huge sequestrated L4-L5 disc. Emergency decompression with laminectomy was done and a large fragment of sequestrated disc found in posterior epidural space was removed. Symptoms improved dramatically following surgery within 10 days. Awareness about this rare disc prolapse is important for timely diagnosis and management of it.

Keywords

• emergency decompression
• low back pain
• posterior epidural space