Dorsal epidural disc migration represents, as the name suggests, migration of disc material, usually a sequestrated disc fragment, into the dorsal (posterior) epidural space, posterior to the theca. This is a rare occurrence, often not suspected preoperatively and is almost invariably encountered in the lumbar region.
Although true epidemiological data is unavailable due to the small number reported and unknown number of undiagnosed cases, there appears to be a male predilection, and a tendency to affect middle to older individuals 1.
Clinical presentation is difficult if not impossible to distinguish from other causes of canal stenosis, such as anterior epidural disc herniations, synovial cysts or epidural haematomas. Patients typically present with cauda equina compression or radiculopathy 1,3.
Dorsal epidural disc migration almost invariably is encountered in the lumbar region, typically L3/4 or L4/5 1. The disc material may be sequestrated (i.e. no communication with the disc space) or merely migrated, with additional material located lateral and anterior to the thecal sac 1.
MRI is the modality of choice for evaluating patients with canal stenosis and/or cord or cauda equina compression. The signal intensity of dorsally migrated disc material is similar to that seen elsewhere; in other words it is of variable signal intensity. Typical signal intensity is as follows 1,2:
- intermediate to low signal
- intermediate to high signal
- may have signal loss centrally if it contains gas
- peripheral enhancement
- rarely solid enhancement is encountered
Treatment and prognosis
Treatment of dorsal epidural disc migration is largely surgical, with laminectomy and resection of the disc material.
- 1. Diehn FE, Maus TP, Morris JM et-al. Uncommon Manifestations of Intervertebral Disk Pathologic Conditions. Radiographics. 2016;36 (3): 801-23. doi:10.1148/rg.2016150223 - Pubmed citation
- 2. Chen CY, Chuang YL, Yao MS et-al. Posterior epidural migration of a sequestrated lumbar disk fragment: MR imaging findings. AJNR Am J Neuroradiol. 2006;27 (7): 1592-4. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 3. Teufack SG, Singh H, Harrop J et-al. Dorsal epidural intervertebral disk herniation with atypical radiographic findings: case report and literature review. J Spinal Cord Med. 2010;33 (3): 268-71. Free text at pubmed - Pubmed citation
- spinal anatomy
- congential abnormalities of the spine
- spinal infection / inflammation / degeneration
- intervertebral disc
- intervertebral disc disease nomenclature
- lumbar disc disease
- acute calcific discitis
- acute disseminated encephalomyelitis (ADEM)
- Charcot-Marie-Tooth disease
- HIV vacuolar myelopathy
- HTLV-1 associated myelopathy (tropical spastic paraparesis)
- multiple sclerosis
- neuromyelitis optica (NMO) - (Devic's disease)
- transverse myelitis
- SCA3 (Machado-Joseph disease)
- subacute combined degeneration of the cord
- subacute necrotizing myelopathy
- tabes dorsalis
- spinal ischaemia
- spinal trauma
- spinal tumours and cysts
- spinal vascular malformations