article = {SSG-2020-1-103}
title = {Cauda Equina Syndrome after Sequestered Disc Herniation Migrating to the Dorsal Epidural Space: Case Report and Review of the Literature}
journal = {Spine and Surgery}
year = {2020}
issn = {}
doi = {http://dx.doi.org/10.31487/j.SSG.2020.01.03}
url = {https://www.sciencerepository.org/cauda-equina-syndrome-after-sequestered-disc-herniation-migrating-to-the_SSG-2020-1-103 
author = {Abdullah Alshammari,Michael  Weber,Rodrigo  Navarro-Ramirez,Susan  Ge,}
keywords = {Migrated disc, spine surgery, discectomy, facet joint cyst}
abstract ={Background: Posteriorly migrated epidural disc fragments (PMEDF) presenting with cauda equina
syndrome are relatively common. These cases are sometimes inaccurately identified on MRI as; epidural
tumors, abscesses, hematomas and or facet cysts. Proper description and identification are key to be able to
provide effective and safe management. Currently we are presenting the case of a patient with cauda equina
syndrome secondary to a posterior mass compression intraoperatively identified as a PMEDF.
Case Description: 45-years-old male presenting with insidious low back pain that progressed to urinary
retention and bilateral foot drop. An MRI of the lumbar spine showed a posteriorly located epidural lesion.
That appeared to be dependent on a left facet cyst. The patient was treated with a decompressive
laminectomy and multiple disc fragments were identified under the ligamentum flavum and over the
posterior epidural space.
Conclusion: Posterior epidural migration of a lumbar disc fragments (PEMLDF) are not a common
presentation of intervertebral disc herniations and their differential diagnosis and treatment might require a
different surgical approach; fusion vs decompression. PEMLDFs should be suspected on those patients
presenting with sudden cauda equina syndrome and posteriorly located epidural lesions on MRI. }