Presentation
Acute low back pain and bilateral sciatica along the S1 dermatome.
Patient Data
T2-hyperintense/T1-isointense oval lesion at the level of L4-L5, centered in the left dorsal epidural space. The L4-L5 disc is mildly degenerated and slightly reduced in height, with an annular fissure. Lumbar MRI with contrast is required for diagnostic purposes.
Axial contrast-enhanced fat-saturated T1-weighted MR shows that the left posterior epidural lesion enhances peripherally.
Symptoms improved with medical therapy (cortisone and analgesics). Thus, a 3-month follow-up with MRI was performed.
At the three-month MRI follow-up, the symptoms have resolved completely. MR images show complete disappearance of the left dorsal epidural lesion.
Case Discussion
This is the case of a dorsal epidural disc herniation with spontaneous clinical and neuroradiological resolution.
Differential diagnosis of a dorsal epidural lesion are tumor, synovial cyst, hematoma, epidural abscess and sequestered dorsal epidural disc herniation 1. Migration of disc material into the dorsal epidural space is a rare phenomenon and often manifests acutely with marked symptoms 2. The levels most commonly affected are L3-L4 and L4-L5 2.
Spontaneous regression of dorsal epidural disc herniation has been reported in many studies 3, thus the course of treatment for this type of disc herniation should be determined based on the symptoms and examination findings, as in cases of ordinary herniation. Early surgical treatment is important if the patient exhibits acute cauda equina syndrome or if the neurologic symptoms worsen over time 3.
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