J Korean Soc Spine Surg.  2019 Sep;26(3):105-110. 10.4184/jkss.2019.26.3.105.

Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine: A Case Report

  • 1Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea. handonglee@gmail.com


STUDY DESIGN: Case report.
To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury. SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury.
A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2-L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2-L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively.
A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient's neurological status had recovered fully at 4 months postoperatively.
This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms.


Posterior migration; Herniated nucleus pulposus; Flexion-distraction injury; Motor weakness; Epidural hematoma
Full Text Links
  • JKSS
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2021 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr