TY - JOUR
AR - SSG-2020-1-103
TI - Cauda Equina Syndrome after Sequestered Disc Herniation Migrating to the Dorsal Epidural Space: Case Report and Review of the Literature
AU - Abdullah, Alshammari
AU - Michael , Weber
AU - Rodrigo , Navarro-Ramirez
AU - Susan , Ge
JO - Spine and Surgery
PY - 2020
DA - Thu 25, Jun 2020
SN - 
DO - http://dx.doi.org/10.31487/j.SSG.2020.01.03
UR - https://www.sciencerepository.org/cauda-equina-syndrome-after-sequestered-disc-herniation-migrating-to-the_SSG-2020-1-103 
KW - Migrated disc, spine surgery, discectomy, facet joint cyst
AB - 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.