Posterior epidural mass: can a posteriorly migrated lumbar disc fragment mimic tumour, haematoma or abscess?

• Published in: Acta orthopaedica belgica Vol. 75; no. 3; pp. 423 - 427
• Main Authors: Derincek, Alihan, Ozalay, Metin, Sen, Orhan, Pourbagher, Ayşin
• Format: Journal Article
• Language: English
• Published: Belgium 01-06-2009
• Subjects: Abscess - diagnosis; Diagnosis, Differential; Epidural Space; Female; Foreign-Body Migration - diagnosis; Hematoma - diagnosis; Humans; Intervertebral Disc Displacement - complications; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Polyradiculopathy - etiology; Spinal Diseases - diagnosis; Spinal Neoplasms - diagnosis; Spondylolisthesis - diagnosis
• ISSN: 0001-6462

A 60-year-old woman complained of low back pain radiating to both buttocks and to the anterior aspect of the left thigh. MRI showed a left posterolateral epidural mass at the L1-L2 level. An epidural abscess was suspected, but the biochemistry was normal. Excision yielded complete relief of symptoms. Pathological examination demonstrated that the specimen was a migrated disc fragment. The authors found 29 other cases of disc migration to the posterior epidural space; two of these were at the thoracic level. Eleven of the 27 lumbar cases (40%) were complicated with Cauda Equina Syndrome (CES). MRI is the method of choice to make the diagnosis. The differential diagnosis includes tumour, haematoma and abscess.