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Case Reports
. 2017:2017:1762047.
doi: 10.1155/2017/1762047. Epub 2017 Jan 10.

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

Alessandro Frati  1 , Alessandro Pesce  2 , Mauro Palmieri  2 , Tommaso Vangelista  1 , Riccardo Caruso  3 , Maurizio Salvati  1 , Antonino Raco  2
Affiliations
Case Reports

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

Alessandro Frati et al. Case Rep Surg. 2017.

Abstract

Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical "corridors" created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots.

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Conflict of interest statement

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interests; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. The authors confirm their adherence to ethical standards and have no financial disclosures that would be a potential conflict of interests with this publication.

Figures

Figure 1
Figure 1
Preoperative MRI scan showing (A) sagittal, (B) axial T2W, (C) axial, and (D) sagittal gadolinium enhanced sequences showing the L2-L3 complete disc extrusion with an anterior-to-posterior circumferential course of the sequestered disc.
Figure 2
Figure 2
Intraoperative picture showing (A) L2 nerve root, (B) dural sac, (C) L3 nerve root, and (D) the posterior extruded segment.
Figure 3
Figure 3
A postoperative MRI scan demonstrating complete resection of the sequestered disc material. Note the decompression of the dural sac and nerve root. L2-L3 arthrectomy and interspinous fixation at the same level were performed.
See this image and copyright information in PMC

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