Extruded lumbar disc associated with epidural hematoma

Abstract

Lumbar disc herniation and spinal epidural hematomas (SEHs) are highly unusual causes of secondary lumbar canal stenosis in the adolescent population. The authors report a unique concomitant occurrence in a 16-year-old boy who presented with left-sided L-5 radiculopathy. Magnetic resonance imaging T1-weighted sequences revealed a left-sided posterolateral prolapsed L4-5 disc with an isointense extruded fragment lying behind the L-5 body. On T2-weighted sequences a hyperintense area was seen in the region of the extruded disc fragment with thecal compression. At surgery the extradural encapsulated hematoma was removed, together with the extruded disc fragment and the L4-5 disc. The characteristics of the biopsy specimen from the epidural collection were consistent with those of a hematoma. At 6 months' follow up, the patient had returned to his normal activities. An SEH may result from tearing of delicate epidural veins following disc extrusion. It can occur at any age, regardless of whether there is a history of significant trauma. Magnetic resonance imaging allows preoperative characterization of the lesion. Results after surgical evacuation are excellent. Distinguishing between a solitary SEH and one caused by a lumbar disc extrusion has significant implications, as the former may resolve completely with conservative management.