Misdiagnosis of posterior sequestered lumbar disc herniation: report of three cases and review of the literature.
Misdiagnosis of posterior sequestered lumbar disc herniation: report of three cases and review of the literature.
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DOI：
10.1038/s41394-018-0100-9
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发表时间：
2018-01-01
影响因子：
1.2
通讯作者：
Romero Martinez, Julia
中科院分区：
文献类型：
--
作者：
Montalvo Afonso, Antonio;Mateo Sierra, Olga;Romero Martinez, Julia
摘要：椎间盘后移是一种极其罕见的事件，它与脊柱肿瘤类似，使其术前诊断和适当治疗变得困难。我们回顾性分析了2006年至2016年我院所有手术治疗的腰椎间盘突出症，以确定后路椎间盘碎片和可能误诊为其他脊柱病变的病例。此外，我们还对后盘移位的误诊病例进行了文献回顾。病例报告：在1153例手术中发现3例后路隔离腰椎间盘（1例硬膜内）。其中2例表现为进行性神经功能缺损，MRI上分别误诊为假瘤病变和脑膜瘤/神经源性肿瘤。经术中诊断和紧急切除，组织学证实椎间盘组织。其余病例术前诊断准确，经过最初的保守治疗后，最终因难治性疼痛接受手术治疗。所有病例均在手术治疗数月后完全恢复。讨论：非肿瘤病变是文献中描述的最常见的后隔离腰椎间盘误诊。由于马尾综合征（CES）的高发，早期手术治疗是标准的治疗方法；然而，最近也有后路隐蔽性腰椎间盘突出症自发性消退的报道。总之，与血肿、滑膜囊肿、脓肿等脊柱后部常见病变相似的低发病率和相似的临床及影像学特征使后路隐匿性椎间盘突出成为诊断上的挑战。尽管CES的发病率很高，但在选择没有神经功能缺损和疼痛控制良好的患者时，应评估最初的保守治疗。
INTRODUCTION: Posterior migration of sequestered disc is an extremely rare event that mimics more common spinal lesions as spinal tumors, making difficult its preoperative diagnosis and appropriate management. We retrospectively reviewed all lumbar disc herniations treated by surgery at our institution from 2006 to 2016 to identify cases with posterior sequestered disc fragments and possible misdiagnosis for other spinal lesions. Complementarily, a literature review of misdiagnosed cases of posterior migrated discs was undertaken.CASE REPORT: Three posterior sequestered lumbar disc cases (one intradural), were found among the 1153 reviewed surgeries. Two of them, presenting with progressive neurological deficit, were respectively misdiagnosed as pseudotumoral lesion and meningioma/neurogenic tumor on MRI. After intraoperative diagnosis and emergent resection, histology confirmed intervertebral disc tissue. The remaining case had an accurate preoperative diagnosis and after an initial conservative management finally underwent surgery because of refractory pain. Full recovery was achieved months after surgical treatment in all cases.DISCUSSION: Non-tumoral lesions are the most frequent misdiagnosis of posterior sequestered lumbar disc described in the literature. Early surgical treatment is the standard management due to high incidence of cauda equine syndrome (CES); however, spontaneous regression of posterior sequestered lumbar disc herniations has been recently reported. In conclusion low incidence and similar clinical and radiological features with other more common posterior spinal lesions like hematomas, synovial cyst or abscess turns posterior sequestered disc herniations a diagnosis challenge. Despite high incidence of CES, an initial conservative management should be evaluated in selected patients without neurological deficit and well-controlled pain.