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Migration of lumbar disc herniation: an unusual case

Ralph J Mobbs1, T R Steel

  • 1Prince of Wales Hospital, Peripheral Nerve Research Foundation, 3 Wansey Road, Randwick, Sydney, NSW 2031, Australia. ralphmobbs@hotmail.com

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|April 14, 2007
PubMed

Insights

A migrating lumbar disc fragment caused a patient's leg pain to shift sides and affect different nerve roots (L3 to L5). This case highlights how extruded disc fragments can migrate significantly from their origin.

Area of Science:

  • Neurosurgery
  • Radiology
  • Spinal Medicine

Background:

  • Lumbar disc herniation is a common cause of radicular pain.
  • Disc fragment migration is a recognized but less common phenomenon.
  • Understanding migration patterns is crucial for accurate diagnosis and treatment planning.

Observation:

  • A patient presented with right-sided L3 radiculopathy, which resolved spontaneously.
  • Over 24 hours, symptoms shifted to left-sided L5 radiculopathy.
  • Magnetic resonance imaging (MRI) confirmed an epidural mass compressing sequential nerve roots.

Findings:

  • The epidural mass, identified as a migrated lumbar disc fragment, showed characteristic hypointense signals on T1- and T2-weighted MRI sequences.
  • The fragment migrated from an initial position affecting the right L3 nerve root to a new location compressing the left L5 nerve root.
  • The patient opted against surgical intervention.

Implications:

  • This case demonstrates the potential for significant, contralateral migration of extruded lumbar disc fragments.
  • Clinicians should consider disc fragment migration when radicular symptoms change or shift.
  • Further research into the biomechanics and imaging characteristics of migrating disc fragments is warranted.

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