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Case Reports in Surgery
Volume 2017 (2017), Article ID 1762047, 4 pages
https://doi.org/10.1155/2017/1762047
Case Report

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

1IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
2Neurosurgery Division, A. O. Sant’Andrea, Via di Grottarossa 1035-1039, 00189 Roma, Italy
3NESMOS Department, Sapienza University of Rome, Roma, Italy
4Department of Neurology and Psychiatry-Neurosurgery, Sapienza University of Rome, Roma, Italy

Correspondence should be addressed to Alessandro Pesce

Received 22 November 2016; Accepted 25 December 2016; Published 10 January 2017

Academic Editor: Jochen Tüttenberg

Copyright © 2017 Alessandro Frati et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots.