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Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine - A Case Report -

  • Journal of Korean Society of Spine Surgery
  • Abbr : J Kor Spine Sur
  • 2019, 26(3), pp.105-110
  • Publisher : Korean Society Of Spine Surgery
  • Research Area : Medicine and Pharmacy > Orthopedic Surgery
  • Published : September 30, 2019

Han-Dong Lee 1,  전창훈 ORD ID 2,  Chung， Nam-Su ORD ID 2,  Hee-Woong Chung 3

1아주대학교병원 정형외과
2아주대학교
3아주대학교 의과대학 정형외과학교실

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ABSTRACT

Study Design: Case report. Objectives: To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury. Summary of Literature Review: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury. Materials and Methods: A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2–L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2–L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively. Results: A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient’s neurological status had recovered fully at 4 months postoperatively. Conclusions: This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms. Key Words: Posterior migration, Herniated nucleus pulposus, Flexion-distraction injury, Motor weakness, Epidural hematoma

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