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Kanbara S, Katayama Y, Matsumoto T, Matsumoto T, Ogura K, Ito Y, Tachi H, Ito K. Posterior spinal cord injury due to dorsal migrated disc herniation caused by thoracolumbar fusion surgery: A case report. J Orthop Sci 2024; 29:445-448. [PMID: 36241559 DOI: 10.1016/j.jos.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/05/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Shunsuke Kanbara
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan.
| | - Yoshito Katayama
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Tomohiro Matsumoto
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Taro Matsumoto
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Keisuke Ogura
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Yuya Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Hiroaki Tachi
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Keigo Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, 455-8530, Japan
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Palmisciano P, Balasubramanian K, Scalia G, Sagoo NS, Haider AS, Bin Alamer O, Chavda V, Chaurasia B, Deora H, Passanisi M, Da Ros V, Giammalva GR, Maugeri R, Iacopino DG, Cicero S, Aoun SG, Umana GE. Posterior epidural intervertebral disc migration and sequestration: A systematic review. J Clin Neurosci 2022; 98:115-126. [PMID: 35152147 DOI: 10.1016/j.jocn.2022.01.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Posterior epidural intervertebral disc migration and sequestration (PEIMS) is a rare and debilitating complication of degenerative disc disease. Radiological differential diagnosis is often challenging, complicating the accurate planning of appropriate treatment strategies. We systematically reviewed the literature on PEIMS, focusing on clinical-radiological features and available treatments. PubMed, Scopus, Web of Science, and Cochrane were searched to include studies reporting clinical data of patients with PEIMS. Clinical characteristics, treatment strategies, and functional outcomes were analyzed. We included 82 studies comprising 157 patients. Median age was 54 years (range, 19-91). PEIMSs occurred spontaneously (49.7%) or acutely in patients with underlying progressive degenerative disc disease (50.3%). The most common symptoms were lower-back pain (77.1%) and radiculopathy (66.2%), mainly involving the L5 nerve root (43.8%). PEIMSs were mostly detected at MRI (93%) and/or CT (7%), frequently located in the lumbar spine (81.5%). Median maximum PEIMS diameter was 2.4 cm (range, 1.2-5.0). Surgical debulking was completed in 150 patients (95.5%), sometimes coupled with decompressive laminectomy (65%) or hemilaminectomy (19.1%). Median follow-up time was 3 months (range, 0.5-36.0). Post-treatment symptomatic improvement was reported in 153 patients (97.5%), with total recovery in 118 (75.2%). All 7 patients (4.5%) who received conservative non-surgical management had total clinical recovery at ≤ 3 months follow-ups. PEIMS is a challenging entity that may severely quality-of-life in patients with degenerative disc disease. Surgical removal represents the gold standard to improve patient's functional status. Spine fusion and conservative strategies proved to be effective in some cases.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | | | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, TX, USA
| | - Othman Bin Alamer
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Vishal Chavda
- Division of Anaesthesia, Sardar Women's Hospital, Ahmedabad, Gujarat, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Maurizio Passanisi
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe R Giammalva
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Domenico G Iacopino
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
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Cultrera F, Nuzzi D, Panzacchi R, Cataldi ML, Lofrese G. A proposal of degenerative anterior epidural cysts of the lumbar spine. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Simão MN, Helms CA, Richardson WJ. Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative microdiscectomy patients. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000400005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. MATERIALS AND METHODS: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. RESULTS: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. CONCLUSION: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified.
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Weiner BK, Patel R. The accuracy of MRI in the detection of lumbar disc containment. J Orthop Surg Res 2008; 3:46. [PMID: 18831743 PMCID: PMC2566558 DOI: 10.1186/1749-799x-3-46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 10/02/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MRI has proven to be an extremely valuable tool in the assessment of normal and pathological spinal anatomy. Accordingly, it is commonly used to assess containment of discal material by the outer fibers of the anulus fibrosus and posterior longitudinal ligaments. Determination of such containment is important to determine candidacy for intradiscal techniques and has prognostic significance. The accuracy of MRI in detecting containment has been insufficiently documented. METHODS The MRI's of fifty consecutive patients undergoing open lumbar microdiscectomy were prospectively evaluated for disc containment by a neuroradiologist and senior spinal surgeon using criteria available in the literature and the classification of Macnab/McCulloch. An independent surgeon then performed the surgery and documented the actual containment status using the same methods. Statistical evaluation of accuracy was undertaken. RESULTS MRI was found to be 72% sensitive, 68% specific, and 70% accurate in detecting containment status of lumbar herniated discs. CONCLUSION MRI may be inaccurate in assessing containment status of lumbar disc herniations in 30% of cases. Given the importance of containment for patient selection for indirect discectomy techniques and intradiscal therapies, coupled with prognostic significance; other methods to assess containment should be employed to assess containment when such alternative interventions are being considered.
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Kim IS, Lee SW, Son BC, Sung JH. Posterior epidural migration of thoracic disc fragment. J Korean Neurosurg Soc 2008; 43:239-41. [PMID: 19096604 DOI: 10.3340/jkns.2008.43.5.239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 05/07/2008] [Indexed: 11/27/2022] Open
Abstract
Migration of a disc fragment to the posterior epidural space is rare, especially in the thoracic spine. Only four such cases of posterior epidural migration of thoracic disc fragments have been reported. The authors report a case of 66-year-old man who presented with back pain and right leg weakness due to posterior epidural migration of thoracic disc fragment. The patient was successfully treated by laminectomy and partial facetectomy with disc removal.
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Affiliation(s)
- Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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Discal cyst of the lumbar spine: MR imaging features. Clin Imaging 2006; 30:326-30. [PMID: 16919553 DOI: 10.1016/j.clinimag.2006.05.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 05/10/2006] [Indexed: 11/28/2022]
Abstract
We describe MR imaging features of discal cyst of the lumbar spine in nine patients who presented with low back pain and leg pain. Discal cyst of the lumbar spine has characteristic MR imaging features different from other epidural cysts: a ventrolateral extradural cyst attached to a herniated lumbar disc, consisting of a thick fibrous capsule without disc material, and having occasional extension into the lateral recess with rim enhancement on contrast-enhanced MR imaging.
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Partheni M, Fratzoglou M, Kalogeropoulou C, Zabakis P, Panagiotopoulos V, Konstantinou D. Dorsal Extradural Thoracic Disc Fragment. ACTA ACUST UNITED AC 2005; 18:544-6. [PMID: 16306848 DOI: 10.1097/01.bsd.0000128055.95837.92] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.
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Affiliation(s)
- M Partheni
- Department of Neurosurgery, University of Patras, Patra, Greece
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Marshman LA, Benjamin JC, David KM, King A, Chawda SJ. “Disc Cysts” and “Posterior Longitudinal Ligament Ganglion Cysts”: Synonymous Entities? Report of Three Cases and Literature Review. Neurosurgery 2005. [DOI: 10.1227/01.neu.0000175866.85346.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Marshman LAG, Benjamin JC, David KM, King A, Chawda SJ. “Disc Cysts” and “Posterior Longitudinal Ligament Ganglion Cysts”: Synonymous Entities? Report of Three Cases and Literature Review. Neurosurgery 2005; 57:E818. [PMID: 17152672 DOI: 10.1093/neurosurgery/57.4.e818] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Extradural cysts intimately associated with relatively normal lumbar discs have rarely been reported. Histologically nonspecific, most have been designated posterior longitudinal ligament (PLL) or annulus fibrosus (AF) "ganglion cysts." Recently, "disc cysts" have been distinguished as a separate entity, mostly on the grounds of cyst-disc communication. CLINICAL PRESENTATION Three young male patients presented with unilateral sciatica. In all cases, magnetic resonance imaging demonstrated rounded, cystic lesions (i.e., hypointense on T1- but hyperintense on T2-weighted scans) adjacent to minimally dehydrated, nonherniated disc spaces. INTERVENTION At surgery, each cyst was found intimately related to either the AF (Case 3) or the PLL (Cases 1 and 2) of the adjacent disc; and direct disc-space communication was evident in Case 3. After cystectomy, with or without discectomy, all patients achieved complete and long-lasting resolution of their sciatic symptoms. Histological appearances were typical of ganglion cysts in all three cases, with evidence of prior hemorrhage in Cases 1 and 3. CONCLUSION Our results and those of others suggest that all such cysts are ganglion cysts that derive from either the AF or the PLL at the disc level. Although disc cysts might be AF ganglion cysts exhibiting disc communication, their separate distinction is probably unnecessary. Cystectomy alone affords complete symptomatic remission; discectomy is usually unnecessary. Although anticipated with ganglia in general, neither spontaneous resolution nor postoperative recurrences have been witnessed. Unlike ganglia in general or juxtafacet ganglion cysts, such cysts seem to be unusually restricted to young men.
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Splendiani A, Puglielli E, De Amicis R, Barile A, Masciocchi C, Gallucci M. Spontaneous resolution of lumbar disk herniation: predictive signs for prognostic evaluation. Neuroradiology 2004; 46:916-22. [PMID: 15609071 DOI: 10.1007/s00234-004-1232-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Accepted: 04/24/2004] [Indexed: 10/26/2022]
Abstract
Spontaneous regression of lumbar disk herniation in patients who did not undergo surgery nor interventional therapy is reported in up to 70% of cases; however, no perspective study has clarified the possible predictive signs of a positive evolution. Aim of our study was to search for plan and contrast enhancement MRI signs able to define disk-herniation resolution. We enrolled 64 patients, affected by 72 lumbar disk herniations as per the classification proposed by the American Society of Neuroradiology (Nomenclature and Classification of Lumbar Disk Pathology 2001). MRI examinations were performed by 1.5-T magnet, using T1w SE sequences on sagittal and axial planes, before and after contrast, and T2w FSE ones on the same planes. The following parameters were considered: age, sex, level and size of disk herniation, its relationship to the spinal canal, clinical onset interval, type of disk herniation, herniated-material signal intensity on T2w sequences and its pattern of contrast enhancement. All the patients, conservatively treated, underwent clinical and MRI follow-up examination after 6 months. At MRI follow-up exams spontaneous regression of disk herniation was observed in 34.72% of cases. Among these, free fragments regressed in 100% of cases, herniations with high signal intensity on T2w sequences in 85.18%, herniations with peripheral contrast-enhancement in 83% of cases. Disk-herniation evolution did not show any relationship with location, size and level. Our study demonstrates that MRI, in addition to its high diagnostic value, offers predictive information about disk-herniation evolution.
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Affiliation(s)
- Alessandra Splendiani
- Department of Radiology, Ospedale S. Salvatore-Coppito, University of L'Aquila, 67100 , L'Aquila, Italy.
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