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

Core Tip

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.