Difficulty differentiating between a posterior extradural lumbar tumor versus sequestered disc even with gadolinum-enhanced MRI

Maurizio Passanisi; Gianluca Scalia; Paolo Palmisciano; Daniele Franceschini; Antonio Crea; Crescenzo Capone; Maria Grazia Tranchina; Giovanni Federico Nicoletti; Salvatore Cicero; Giuseppe Emmanuele Umana

doi:10.25259/SNI_504_2021

Difficulty differentiating between a posterior extradural lumbar tumor versus sequestered disc even with gadolinum-enhanced MRI

Surg Neurol Int. 2021 Jun 7:12:267. doi: 10.25259/SNI_504_2021. eCollection 2021.

Affiliations

¹ Department of Neurosurgery, Cannizzaro Hospital, Sicily, Italy.
² Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Sicily, Italy.
³ Department of Neurosurgery and Institute of Intensive Care Medicine, University Hospital and University of Zürich, Zurich, Switzerland.
⁴ Department of Pathological Anatomy, Cannizzaro Hospital, Catania, Italy.

Abstract

Background: Differentiating between posterior extradural tumors versus sequestered lumbar disc herniations may be difficult even utilizing contrast-enhanced MR scans.

Case description: A 49-year-old male acutely presented with an incomplete cauda equine syndrome. When the MRI showed a L4-L5 posterior extradural lesion that enhanced with gadolinium, an urgent left hemilaminectomy was performed. The lesion proved to be a sequestrated disc herniation rather than a tumor. Notably, postoperatively the patient almost completely recovered after 6-month follow-up.

Conclusion: Even on contrast-enhanced MRI studies, posterior extradural sequestered lumbar disc herniations may mimic tumors.

Keywords: Cauda equina; Low back pain; Lumbar disc; MRI; Posterior epidural migration.

Publication types

Case Reports