Posterior epidural migration of herniated lumbar disc fragment: Experience with 11 cases

Abstract

ABSTRACT
Background: Lumber disc herniation is a common entity in neurosurgical practice. The herniated disc fragment may migrate ventrally or laterally after penetrating the posterior longitudinal ligament. Posterior epidural migration of the ruptured fragment is comparatively uncommon and may mimic clinically and radiologically with spinal tumors. The objective of this study was to analyze patients with posterior epidural migration of lumber disc for clinical features, diagnosis and outcome of surgery. Material and Methods: This retrospective study was conducted at the Department of Neurosurgery, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar from July 2007 to June, 2012 (5 years). All Patients who had posterior epidural migration of herniated lumbar disc fragment and undergone surgery (discectomy) were included in the study. Patients who had anterior or lateral epidural disc fragments or having recurrent lumber disc herniation were excluded from the study. The clinical record of the patients was evaluated for clinical features, diagnosis and outcome of surgery. Results: Out of 11 cases, 8 were males and 3 females with male to female ratio of 2.7: 1. The mean age of the patients was 42.5 (16 to 69) years. Six (54.5%) patients had radicular symptoms followed by Cauda Equina syndrome in three (27.3%) and neurogenic claudication in two (18.2%) patients. Preoperative diagnosis was that of ruptured disc fragment in eight (72.7%) cases. 90 % patients had good results after surgery. Conclusions: The most common clinical feature of posterior epidural migration of herniated lumbar disc fragments was that of radicular symptoms. Magnetic resonance imaging (MRI) is the investigation of choice but not diagnostic in all the cases. Most of the patients had good response to surgery.