Diagnosis and surgical challenges of extremely severe head and lumbar disc herniation in young patients: A case report

Abstract

BACKGROUND

Lumbar disc extrusion, a common spinal disorder, is particularly uncommon in its severely displaced form, especially in young patients. This condition can pose diagnostic challenges due to its nonspecific presentation.

CASE SUMMARY

A 36-year-old male patient presented with persistent low back pain and radiating leg pain lasting half a month, which had worsened over the previous four days. Lumbar magnetic resonance imaging scans showed an abnormal signal within the vertebral canal at the L3 level, suggesting either a disc cyst or an epidural hematoma. Based on these findings, the patient was provisionally diagnosed with either condition. Surgical exploration was conducted, revealing an extruded lumbar disc, which was subsequently excised. Following surgery, the patient's symptoms completely resolved.

CONCLUSION

High-grade lumbar disc extrusion in young patients is rare but should be considered in sedentary, physically inactive individuals presenting with lumbocrural pain and abnormal magnetic resonance imaging findings. Early and accurate diagnosis is crucial to avoid misdiagnosis, and prompt open surgery may be necessary in severe cases to alleviate symptoms. The case highlights the impotance of a thorough diagnostic workup and timely surgical intervention in managing such rare but potentially severe spinal disorders.

Keywords: Lumbar disc extrusion; Cephalad; Open surgery; Clinical implications; Diagnostic assessment; Case report

Core Tip: This case report introduces a unique case of high cephalad migration of lumbar disc herniation in a 36-year-old male patient. The patient exhibited persistent low back pain and radiating leg pain, with symptoms worsening over time. Lumbar magnetic resonance imaging scans revealed an abnormal signal within the vertebral canal at the L3 level. Physical examination demonstrated tenderness in the lumbar region, restricted lumbar spine mobility, and numbness and sensory decrement in the right lower limb. Differential diagnoses included discal cysts and spinal epidural hematomas. Due to the rarity and challenging nature of the lesion's location, open surgery was selected as the treatment option. Intraoperative ultrasonography facilitated precise localization of the lesion, which was successfully resected. The postoperative outcome was favorable, with complete resolution of symptoms and a Visual Analog Scale score of 0. This case underscores the importance of considering atypical pathogenic mechanisms in young patients with lumbar disc herniation and highlights the role of intraoperative ultrasonography in guiding surgical management.