Objective

To talk through our observation and a review of the literature about radiological features and diagnostic difficulties of this particular form of disk migration.

Observations

We report the case of a 29 year-old patient who presented following the wearing of a heavy load bilateral acute lombosciatalgies associated with a deficit of both lower limbs and urinary incontinence. Clinical examination revealed a motor deficit of sural triceps and foot relievers estimated1 in bilateral, hypoesthesia of the anterolateral side of the two legs and the feet, low bone tendon reflexes were abolished, anesthesia in the saddle, hypotonic anal sphincter and bladder distension. MRI of the lumbar spine showed a herniated disc L3-L4 excluded with right posterior epidural migration compressing the dural sheath. Surgical treatment (decompression and herniectomie) was undertaken in emergency. Partial sensorimotor recovery was observed. In two months of decline, the patient still has a distal deficit of both lower limbs, bladder sphincter disorders for which he is under self-intermittent catheterization.

Discussion – conclusion

Posterior epidural disc herniation migration is exceptional. Its diagnosis is difficult and often takes the form of an intraspinal tumor lesion. Its clinical manifestations are varied to the extreme with a cauda equina syndrome. MRI with injection is the best diagnostic tool. We may always consider this diagnosis in front of a posterior epidural mass with taking a device contrast. Emergency surgery is necessary to prevent serious neurological deficits.