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PubMed1999

Pyogenic psoas abscess: analysis of 27 cases.

From 1993 to 1998, 29 pyogenic psoas abscesses occurring in 27 patients were seen in Taichung Veterans General Hospital. Their age range was 25 to 85 years. Diabetes mellitus was the leading underlying disease. Fever and pain in the flank area, back and hip were the usual manifestations. The duration of symptoms prior to the diagnosis ranged from 3 days to 6 months. Most abscesses were diagnosed by computed tomography (CT) images and proven by abscess cultures, which were divided into primary and secondary types. Eighteen of 29 abscesses were regarded as primary. Staphylococcus aureus was the most common pathogen in the primary abscesses, followed by Streptococcus agalactiae, Escherichia coli, viridans streptococci, S. epidermidis, and Salmonella spp.. In the secondary abscess category, E. coli was the leading organism in this series, followed by S. aureus, Klebsiella pneumoniae, viridans streptococci and Candida albicans. The associated conditions included epidural abscess, osteomyelitis, septic arthritis, perirenal abscess, pulmonary tuberculosis, empyema, hydronephrosis and trauma history. The initial empiric therapy comprised mostly of cefazolin or oxacillin with or without an aminoglycoside. Thirteen patients underwent percutaneous drainage, while six received surgical debridement, including two with a recurrent abscess. One patient had both drainage and debridement. Others received medical treatment only. Two of the patients with primary abscess died in spite of percutaneous drainage. Therefore, open drainage, besides appropriate antibiotic treatment, is still required to control complex abscesses with sepsis.

Adult↗
PubMed2006

Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis.

OBJECTIVES: Magnetic resonance imaging (MRI) and computed tomography (CT) are useful for initial assessment of bacterial spondylodiscitis. However, clinical relevance of imaging changes during treatment is less well-documented. METHODS: Between October 1997 and March 2005, 29 patients with documented bacterial spondylodiscitis were prospectively enrolled. They had clinical, biological and imaging examinations (MRI and/or CT) at M0 and M3, and in 22 cases, at M6. RESULTS: Mean age was 58 yrs. Antimicrobial chemotherapy lasted an average of 98 days. The median follow-up was 18 months, including 12 months after the completion of treatment. Infection was cured in every patient. Biological markers of inflammation returned to normal at M3. Six patients had painful and/or neurological sequelae. Decreased disc height was a consistent and early sign, and remained stable during the follow-up. Vertebral oedema, present in 100% of cases initially, persisted in 67 and 15% of cases at M3 and M6, respectively. Discal abscesses and paravertebral abscesses, present in 65 and 39% of cases initially, persisted in, respectively, 42 and 9% of cases at M3 and in 18 and 3% of cases at M6. Epidural abscesses were present at diagnosis in 30% of cases, and had always disappeared by M3. Imaging abnormalities found at M0 and M3 did not differ between patients with and without late neurological or painful sequelae. CONCLUSIONS: Imaging abnormalities often persist in patients with bacterial spondylodiscitis despite a favourable clinical and biological response to antibiotic treatment. They are not associated with relapses, neurological sequelae or persistent pain. Imaging controls are not necessary when bacterial spondylodiscitis responds favourably to treatment.

Adult↗
PubMed1987

[Lumbar epidural hematoma and spinal abscess following peridural anesthesia].

Epidural application of local anesthetics or opiates is commonly used for treatment of severe pain or arterial obstruction. We discuss two cases of complications following peridural anesthesia. As an acute complication, a lumbar epidural hematoma developed hours after placement of the catheter and caused sciatic pain and nearly complete paraplegia. The hemorrhage might have been promoted by heparinization. After decompressive hemilaminectomy the patient recovered but was disabled by a persistent paresis. The second patient suffered from renal failure, arterial obstruction, and phantom limb pain. A peridural catheter was kept in place for 6 weeks. Five months later the patient developed severe sciatica. Spinal computed tomography showed compression of the cauda at the L4/5 level (Fig.4) caused by an abscess that was opened and drained. After insertion of a gentamicin - PMMA - chain (Septopal), the wound healed primarily but the patient suffered from persistent pain. The incidence of vessel puncture after insertion of a peridural catheter is about 1%-10%. The risk of hemorrhage, perforation of the dura, and nerve root irritation is increased in scoliotic or elderly patients with a narrow spinal canal. Persistent pain after removal of the catheter is the most important sign. Although paraplegias following peridural catheterization can occur without anticoagulants, even low-dose heparinization is potentially dangerous. The risk of infectious complications after long-term peridural catheterization may be up to 20%. Hematogenous metastatic infection is more common in patients with malignancies or multiple risk factors than continuous immigration of bacteria. Epidural hematomas and spinal abscesses can cause disability and persistent neurological deficit in spite of aggressive surgical and antibiotic therapy.

Abscess↗
PubMed2004

Severe neurological complications after central neuraxial blockades in Sweden 1990-1999.

BACKGROUND: Central neuraxial blockades find widespread applications. Severe complications are believed to be extremely rare, but the incidence is probably underestimated. METHODS: A retrospective study of severe neurologic complications after central neuraxial blockades in Sweden 1990-1999 was performed. Information was obtained from a postal survey and administrative files in the health care system. During the study period approximately 1,260,000 spinal blockades and 450,000 epidural blockades were administered, including 200,000 epidural blockades for pain relief in labor. RESULTS: : The 127 complications found included spinal hematoma (33), cauda equina syndrome (32), meningitis (29), epidural abscess (13), and miscellaneous (20). Permanent neurologic damage was observed in 85 patients. Incidence of complications after spinal blockade was within 1:20-30,000 in all patient groups. Incidence after obstetric epidural blockade was 1:25,000; in the remaining patients it was 1:3600 (P < 0.0001). Spinal hematoma after obstetric epidural blockade carried the incidence 1:200,000, significantly lower than the incidence 1:3,600 females subject to knee arthroplasty (P < 0.0001). CONCLUSIONS: : More complications than expected were found, probably as a result of the comprehensive study design. Half of the complications were retrieved exclusively from administrative files. Complications occur significantly more often after epidural blockade than after spinal blockade, and the complications are different. Obstetric patients carry significantly lower incidence of complications. Osteoporosis is proposed as a previously neglected risk factor. Close surveillance after central neuraxial blockade is mandatory for safe practice.

Anesthesia, Epidural↗
PubMed1993

[Subdural abscess. Rare complication of epidural infiltration. Apropos of a case and review of the literature].

Lumbar subdural abscesses have rarely been reported in the literature, and the complications of epidural infiltrations predominantly include arachnoiditis, meningitis and epidural abscesses. We report a case of lumbar subdural abscess confirmed by surgery, which appeared following epidural infiltration for lumbar sciatica and was examined with computed tomography and MRI. Only the latter technique alone showed the abscess, after gadolinium injection, and established its intradural site.

Adrenal Cortex Hormones↗
PubMed2001

Paravertebral abscess formation and knee arthritis due to brucellosis in a patient with rheumatoid arthritis.

OBJECTIVE: To report a case of Brucellosis causing severe joint and vertebra destruction in a patient with rheumatoid arthritis (RA). SETTING: Ankara, Turkey. CASE REPORT: A 47-year-old man with a known diagnosis of (RA) for 5 years developed paravertebral and epidural abscesses and vertebral fractures and nerve root compression due to brucellosis. The patient underwent surgery for L3-L4 vertebra stabilisation and medical treatment for knee arthritis. CONCLUSION: It is important to be aware of the possibility of brucellosis in endemic areas, even among patients with a known diagnosis of RA presenting with clinical pictures that may be confused with a flare-up of the RA itself. Steroids and NSAIDs may have the potential to mask disease manifestations.

Abscess↗
PubMed2001

Pott's puffy tumour: still not an eradicated entity.

Pott's puffy tumour is an infrequent entity characterised by one or more subperiosteal abscesses associated with frontal bone osteomyelitis. Although cases in patients of all ages have been reported, teenagers are the most frequently affected. Early diagnosis and aggressive treatment are essential because of the high risk of severe neurological complications, such as epidural abscess, subdural empyema, and secondary septic thrombosis of the dural sinuses. This paper describes the case of a patient with a subperiosteal abscess resulting from sinusitis, with orbital and intracranial extension, and subsequent neurological complications. Despite modern methods of diagnosis and treatment, 13 new cases have been published in the last 5 years; in at least 3 (23%) of these cases there were serious neurological complications. Upper respiratory infections and sinusitis are leading causes of visits to the emergency department in the paediatric age group; however, no risk factors for poor outcome have so far been identified in any of these patients.

Abscess↗
PubMedDate not supplied

Acute mastoiditis: a review of 69 cases.

Sixty-nine cases of acute mastoiditis were managed at the Kaplan Hospital in Israel during a 10-year period. About two thirds (68%) recovered with conservative therapy consisting of wide myringotomy and intravenous antimicrobial therapy, usually ampicillin and cloxacillin. One third (22 patients) were managed surgically by complete mastoidectomy. Indications for surgery were subperiosteal abscess, based on clinical findings in 20 patients; one had septic fever that did not respond to antimicrobial therapy, and one had signs of meningeal irritation. Mastoid radiographs played no role in the decision to operate. Four cases of unsuspected epidural abscess were found, two behind intact tegmental bone. Acute mastoiditis develops mostly in ears that have not been immune to previous infections; thus the mucosal barrier is broken easily and osteitis occurs. Although with the advent of antimicrobial therapy the presentation and course of the disease are milder, the disease is still serious and potentially lethal.

Abscess↗
PubMed1998

Cost-benefit value of microscopic examination of intervertebral discs.

OBJECT: Given the virtual absence of histologically detected, clinically unsuspected disease in intervertebral disc specimens, some authors have advocated that histological examination be discontinued. However, the examination of intervertebral disc specimens remains common practice in most pathology laboratories. No cost-benefit analysis of this practice has been made; therefore, the authors' goal in this study was perform such an analysis. METHODS: Using the University of Iowa surgical pathology database, 1109 patients who had undergone a laminectomy were identified retrospectively. These cases were classified into four categories based on the patients' preoperative clinical diagnosis and final histopathological diagnosis: insignificant clinical diagnosis/insignificant pathological diagnosis (ICIP), significant clinical diagnosis/insignificant pathological diagnosis (SCIP), significant clinical diagnosis/significant pathological diagnosis (SCSP), and insignificant clinical diagnosis/significant pathological diagnosis (ICSP). A significant clinical diagnosis was defined as one other than a benign, noninfectious indication for laminectomy. A significant pathological diagnosis was a diagnosis other than degenerative changes. The cost-benefit value of performing a histological examination in cases with significant or insignificant clinical diagnoses was examined. The cases were classified as: 1068 ICIP, 17 SCIP, 21 SCSP, and three ICSP. On chart review, in all three cases of ICSP an epidural abscess was identified perioperatively and the subsequent histological diagnosis did not affect patient care. The costs per case of identifying a significant pathological diagnosis with a significant and an insignificant clinical diagnosis were $44.79 and $8811, respectively. CONCLUSIONS: Histological examination of intervertebral disc specimens is cost beneficial only if there is a significant preoperative clinical diagnosis.

Abscess↗
PubMed1998

Efficacy and technical complications of long-term continuous intraspinal infusions of opioid and/or bupivacaine in refractory nonmalignant pain: a comparison between the epidural and the intrathecal approach with externalized or implanted catheters and infusion pumps.

OBJECTIVE: To compare efficacies, failure rates, and technical complication rates of intraspinal treatments in patients with "refractory" nonmalignant pain conditions in relation to the approach (epidural/intrathecal), the drug (opioid/opioid-bupivacaine or bupivacaine), and the type of system used (externalized/internalized). In these comparisons, recent data from a companion paper (Nitescu et al., Clin J Pain 1998;14:17-28) were used as a reference to be compared with data from a literature review of different intraspinal treatment modalities in nonmalignant pain. DESIGN: Prospective, cohort, nonrandomized, consecutive trial. SETTING: Tertiary care center, institutional practice, hospitalized, and ambulatory care. PATIENTS: Five groups according to treatment modality: (a) externalized, long-term intrathecal nylon catheters, connected to external, electronic infusion pumps (companion paper), n = 90; (b) internalized, long-term intrathecal catheters (Silastic) connected to implanted SynchroMed pumps, n = 330 (literature review); (c) externalized, "short-term" epidural catheters for "temporary" infusions, n = 565 (literature review); (d) externalized, long-term epidural catheters, n = 50 (literature review); (e) internalized, long-term epidural catheters, n = 111, connected to implanted systems: Port-A-Cath injection ports, n = 58; Infusaid pumps, n = 46; and SynchroMed pumps, n = 7 (literature review). INTERVENTIONS: In reviewing the literature, we found 21 studies that reported on the intraspinal (epidural or intrathecal) administration of opioids with or without local anesthetics (usually bupivacaine). These studies were analyzed with respect to the rates of the variables satisfactory pain relief (efficacy), failures, and technical complications. A rate is the number of observations of a variable divided by the number of patients or the number of catheters or infusion systems, as logically indicated (e.g., the numbers of complications, such as epidural abscess and meningitis, were related to the number of patients and those of catheter occlusion or leakage to the number of the catheters). The variables were expressed as the means of the rates of a variable from studies belonging to various treatment modalities: approach (epidural vs. intrathecal), duration (short vs. long term), drugs administered intraspinally (opioid vs. opioid and/or local anesthetic), and type of infusion system (externalized vs. internalized). Further, the sums of all observations of one variable in different studies with various treatment modalities were related to the corresponding sums of the patients (alternatively, catheters or implanted devices). The proportions of these sums were tested for significance in relation to treatment modality. MAIN OUTCOME MEASURES: Comparative rates of successful intraspinal treatment and its failures and complications. RESULTS: (a) The intrathecal approach, compared with the epidural approach, was associated with higher rates of satisfactory pain relief for both externalized (86/90, 95% vs. 17/40, 42.5%, p < .0001) and internalized (295/336, 89% vs. 33/56, 59%, p < .0001) catheters; higher rates of treatment failures with externalized epidural catheters than with internalized intrathecal catheters (24/47, 51%, vs. 36/338, 11%, p < .0001); lower rates of treatment failures with internalized intrathecal catheters than with internalized epidural catheters (36/338, 11% vs. 29/76, 38%, p < .0001); higher rates of system replacement with internalized epidural catheters than with internalized intrathecal catheters (23/32, 72% vs. 6/49, 12%, p < .0001; higher rates of system removal with internalized epidural catheters than with internalized intrathecal catheters (22/49, 45% vs. 5/49, 10%, p < .001); higher rates of catheter-related complications with epidural than with intrathecal catheters (dislodgement 13/126, approximately 10% vs. 6/150, 4%, p < .05; leakage 5/51, approximately 10% vs. 1/116, 0.9%, p < .05; obstruction 2

Anesthetics, Local↗
PubMed1979

Association of teichoic acid antibody with metastatic sequelae of catheter-associated Staphylococcus aureus bacteremia: a failure of the two-week antibiotic treatment.

A patient with Staphylococcus aureus bacteremia associated with an infected intravenous catheter was treated with oxacillin for two weeks. During that period all blood cultures were sterile, he rapidly became afebrile, and there were no signs of endocarditis or metastatic abscesses. However, serum antibodies against staphylococcal teichoic acid, initially undetectable by the agar gel immunodiffusion technic, became positive during the second week of treatment. Three weeks after discharge, the patient was readmitted to the hospital because of back pain and weakness in the lower extremities. Vertebral osteomyelitis and a spinal epidural abscess caused by Staph. aureus of the same phage type as the bacteremic isolate were demonstrated. This case illustrates the importance of careful follow-up of patients with Staph. aureus bacteremia and the potential value of serial measurement of teichoic acid antibodies in detecting clinically inapparent complications of infection.

Abscess↗
PubMed2003

Neurologic deficits and arachnoiditis following neuroaxial anesthesia.

Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.

Anesthesia, Spinal↗
PubMed1998

Epidural analgesia: prospective audit of 1062 patients.

A prospective survey of one thousand and sixty-two patients receiving epidural analgesia in surgical wards was undertaken over a two-year period. The duration of infusion ranged from one to fourteen days, with a mode of three days. There were 1131 episodes where a local anaesthetic and opioid mixture was used and 160 where opioids were used alone. Local anaesthetic was not used without opioids. 23% of catheters were removed prematurely because of catheter related problems including accidental dislodgement (13%) and skin site inflammation (5.3%). No epidural abscess or haematoma was identified. In 14% of the total number of episodes there was either no demonstrable block or complications occurred requiring a change of solution: 30% of this group were salvaged following intervention by the Acute Pain Service (APS). The incidence of respiratory depression was 0.24%. There was no case of delayed respiratory depression. Epidural analgesia can be used safely in surgical wards provided that regular review of the patients is undertaken. It must be anticipated however, that up to 20% of patients will not receive adequate analgesia for the first 48 hours postoperatively. The failure rate could be halved if accidental dislodgement of epidural catheters could be eliminated.

Adolescent↗
PubMedDate not supplied

Tuberculous spondylitis: epidemiologic and clinical study in non-HIV patients from northwest Spain.

OBJECTIVES: To study the epidemiology, clinical features, and outcome of non-human immunodeficiency virus (HIV) patients diagnosed with tuberculous spondylitis (TS) in a well-defined region of northwestern Spain. METHODS: Retrospective chart review of patients older than 14 years of age diagnosed with TS at two contiguous areas between 1986 and 1999. RESULTS: Thirty-seven patients (19 men; mean age 60.3 years) were diagnosed with TS. The average annual incidence rate of TS was 0.55/100,000 population 15 years of age and older. The thoracic and lumbar regions were affected in most cases. The mean duration of symptoms before diagnosis was 28 weeks (range 3-129). Active or healed pulmonary tuberculosis was observed in only 30%. The tuberculin skin test was negative in 24%. The most common findings at the time of diagnosis were back pain and elevated ESR (either 89%). Of note, only 19% had fever. On admission plain radiographs disclosed the presence of spondylitis in 84% of the patients. Computed tomography scan and magnetic resonance imaging yielded conclusive diagnostic data in the cases with normal radiographs, and were very useful in the visualization of abscesses and intraspinal compression. Cultures of material from percutaneous needle aspiration and open bone biopsy were positive for Mycobacterium tuberculosis in 79% and 77% of the cases, respectively. Antituberculous therapy was given to all patients (mean duration of treatment 44 weeks). Surgical procedures were performed in 12 cases, in 7 of them to remove paraspinal and/or epidural abscesses, and in 5 because of neurological complications. Local pain and neurological deficits were the mostfrequent sequelae (16 and 8 cases, respectively). One patient died during the course of treatment due to a co-morbid disease. None of the patients had relapses of tuberculosis. CONCLUSION: TS is a major cause of morbidity. There is a long delay to the diagnosis in most patients. Awareness of its clinical features and early therapy are required to reduce severe complications.

Adult↗
PubMed1999

Management of lateral sinus thrombosis.

OBJECTIVES: Review the clinical signs and symptoms, management, bacteriology and outcomes of patients treated for lateral sinus thrombosis. STUDY DESIGN: A retrospective review of six patients, treated from 1993 through 1998, with an intraoperatively confirmed diagnosis of lateral sinus thrombosis. METHODS: All charts from 1993 through 1998 coded for sinus thrombosis, meningitis, brain abscess, otitic hydrocephalus, subdural abscess, and mastoidectomy were reviewed. Operative reports, radiological examinations, laboratory data, culture data and other pertinent data were reviewed. RESULTS: The presenting symptoms ranged from headache to mental status changes. All patients had a history of chronic ear disease and all had at least one additional intracranial complication. The range of additional intracranial complications included otitic hydrocephalus, epidural abscess, and brain abscess. All of the infections were polymicrobial, with a predominance of anaerobes. There were no mortalities; morbidities included anacusis, acute respiratory distress syndrome, reoperation, seizures, septic cardiomyopathy, transfusion, ventriculoperitoneal shunt and nutritional supplementation. CONCLUSION: In patients with otologic disease, complaints of headache, earache or photophobia should warrant an evaluation. The presence of lateral sinus thrombosis mandates further investigation for additional intracranial complications. Conservative surgical intervention, consisting of removal of all perisinus infection and needle aspiration of the sinus, has been found to be effective. Lateral sinus thrombosis is an uncommon complication of otitis media, with potentially significant morbidities, necessitating a high index of suspicion.

Adolescent↗
PubMed2007

Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis: results of 15 patients with serious comorbid conditions.

STUDY DESIGN: Clinical results of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage for pyogenic spondylodiscitis were analyzed. OBJECTIVES: To report clinical results of transforaminal endoscopic surgery for pyogenic spondylodiscitis and to evaluate the effectiveness of this procedure in treatment of pyogenic spinal infections. SUMMARY OF BACKGROUND DATA: Pyogenic spinal infections have been increasing due to the development of medical treatment for patients with comorbid medical problems. Common treatments for spinal infections are administration of antibiotics or surgical debridement with bone grafts. There have been no reports, however, regarding the clinical outcome of posterolateral endoscopic treatment for pyogenic spinal infections. METHODS: Fifteen consecutive patients with pyogenic spondylodiscitis in the thoracic or lumbar spine were enrolled. Preoperative antibiotic treatment had failed in all the patients. The procedures consisted of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage through single portal under the combination of local and intravenous anesthesia. Pain response using visual analog scale (VAS, 0-100 mm), inflammation parameters, and duration of antibiotic therapy were investigated. Radiologic evaluation focused on bony fusion, local kyphosis, disc height reduction, and abscess formation. RESULTS: All patients showed immediate pain reduction after surgery. Averaged VAS for pain was 86 before surgery and 25 at postoperative 1 week. Average of CRP was 4.00 mg/dL before surgery and 1.88 mg/dL at postoperative 1 week. Averaged duration of antibiotics therapy was 3.7 weeks. Spinal fusion was obtained in 13 patients. Two patients with neurologic deficits due to epidural abscess returned to normal. Preoperative psoas abscess in 6 patients disappeared after surgery on MRI. CONCLUSIONS: Posterolateral spinal endoscopic debridement and irrigation brought immediate pain reduction and good clinical results to patients who had comorbid medical problems and had pyogenic spondylodiscitis.

Adolescent↗
PubMed1998

Posterior epidural migration of an extruded lumbar disc fragment causing cauda equina syndrome. Clinical and magnetic resonance imaging evaluation.

STUDY DESIGN: Retrospective case report. OBJECTIVES: To illustrate the rare occurrence of cauda equina syndrome resulting from posterior epidural disc fragment migration documented by magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: Disc fragment migration patterns are generally limited by the attachments of the posterior longitudinal ligament and its associated "midline septum" and "peridural" or "lateral membrane." The majority of symptomatic lumbar disc herniations are noted to be in a lateral position with resultant nerve root irritation. Although caudal, rostral, and lateral migration of disc fragments are common, posterior epidural migration of an extruded disc fragment has been reported only rarely, and only once in association with cauda equina syndrome. METHODS: The patient described in this report presented with an acute cauda equina syndrome. Investigation with magnetic resonance imaging revealed a posterior epidural mass, which was hypointense on T1-weighted and T2-weighted images. Postgadolinium imaging showed rim enhancement of the lesion. The preoperative differential diagnosis included epidural abscess, hematoma, or neoplasm. An urgent decompressive lumbar laminectomy was performed. At surgery, the lesion proved to be a massive extruded disc fragment. RESULTS: At the 1-year follow-up examination, the patient had recovered full motor, sensory, urologic, and sexual function. CONCLUSIONS: Extruded disc fragments may migrate posterior to the thecal sac. Magnetic resonance images of a posterior disc fragment may mimic those of other more common posterior epidural lesions.

Cauda Equina↗