ABSTRACT

OBJECTIVE:

Posterior epidural migratian (PEM) of sequestered disk fragment is rare, but magnetic resonance imaging (MRI) technics facilitate to diagnosis. Reported PEM patients presented with radiculopaty or cauda equina syndrome (CES). There are only case reporıs in the literature. Early diagnosis and adequate surgical treatment are important to prevent for severe neurologic deficits.

METHODS:

Between 1995 and 2008, eight cases who had posterior migrated lumbar disc fragment were evaluated. Duration of symptoms (mean 4.2), age distribution (mean 52.7) and male female ratio (6: 2) were investigated. Sequestered disc fragment in five patients (62.5%) were shown L3-L4 disc level. In more of the patients, tumor like ring contrast enhancement around sequestered fragment in magnetic resonance images (MRI) were shown. Postoperative outcomes are evaluated by modified Odom's criteria and visual analoge scale (VAS) pain score.

RESULTS:

Microsurgical approaches were applied all cases. As a treatment, minimal hemilaminotomy and to remove a free fragment was performed. Six patients had excellent or good Odom's criteria in postoperative period.

CONCLUSION:

Surgery should be performed early to prevent severe neurologic deficits. As a surgical treatment, removed a free fragment with hemilaminotomy and sequestrectomy were adequate. The surgical outcome is depended on preoperative symptom's duration. As a clinical series, this study is first in literature.