Li J, Gössel L, Kunze B, Kessler O, Alharbi Y, Gärtner O, Mihalca V, Krebs S, Dreimann M.
Traumatic lumbar disc herniation: A systemic case review and meta-analysis.
Brain Spine 2023;
3:102350. [PMID:
38021008 PMCID:
PMC10668050 DOI:
10.1016/j.bas.2023.102350]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023]
Abstract
Introduction
Traumatic lumbar disc herniation (TLDH) without fracture in the in-situ motion segment is a rare occurrence compared with degenerative herniation.
Research question
This study provides a systematic discussion of various aspects related to the diagnosis of TLDH.
Material and methods
This review includes 12 cases of TLDH with MR-images since 2009 published in the PubMed and one adjunct illustration. The cases were categorized into two groups for a comprehensive analysis, TLDH with or without in-situ segment fracture. Additionally, we reported a case of a 43-year-old female patient with a recent stenosing TLDH at L5/S1, accompanied by a large sequestration (disc herniation stage-4, and Michigan State University Classification: MSU 3-AB) and an endplate compression fracture at L2 (AO A1).
Results
Isolated traumatic lumbar disc herniation is possible, but it is required exclude cases with fractures in the in-situ motion segment.
Discussion and conclusion
Trauma with related injury mechanisms is the highest priority for the diagnosis of TLDH. Low-grade disc degeneration without significant instability could be accepted for diagnosing TLDH. A TLDH on MR images might show a slightly lower T2-signal compared to the CSF and a homogeneous T1-signal like the spinal cord, as well as a similar STIR-signal of the sequestration and CSF. If necessary, a histological examination could be performed to evaluate the degenerative changes in the injured disc, especially to assist the evaluation due to legal reasons.
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