Spontaneous regression of posterior epidural migrated lumbar disc fragments: case series.

BACKGROUND CONTEXT: Posterior epidural migrated lumbar disc fragments is an extremely rare disorder. Surgical treatment was performed in all reported cases. To the best of our knowledge, there are no reported cases of the use of conservative treatment for posterior epidural migrated lumbar disc fragments. PURPOSE: To report the possibility of a spontaneous regression of posterior epidural migrated lumbar disc fragments. STUDY DESIGN: Case series. METHODS: Four patients with posterior epidural migrated lumbar disc fragments were treated at Karatsu Red Cross Hospital between April 2008 and August 2010. Spontaneous regression of the posterior epidural migrated lumbar disc fragments with relief of symptoms was observed on magnetic resonance imaging (MRI) in three cases. Another patient underwent surgical treatment. The present and previously reported cases of posterior epidural migrated lumbar disc fragments were analyzed with respect to patient age, imaging features on MRI, the level of the lesion, clinical symptoms, treatment, and outcomes. RESULTS: Conservative treatment was successful, and spontaneous lesion regression was seen on MRI with symptom relief in three cases. CONCLUSIONS: Although posterior epidural migrated lumbar disc fragment cases are generally treated surgically, the condition can regress spontaneously over time, as do sequestrated disc fragments. Spontaneous regression of lumbar disc herniations is a widely accepted observation at present. Posterior epidural migrated lumbar disc fragments fall under the sequestrated type of disc herniation. In fact, the course of treatment for posterior epidural migrated lumbar disc fragments should be determined based on the symptoms and examination findings, as in cases of ordinary herniation. However, providing early surgical treatment is important if the patient has acute cauda equina syndrome or the neurologic symptoms worsen over time.

Myxoid liposarcoma with negative features on bone scan and [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography.

BACKGROUND: Myxoid liposarcoma occurs in middle age, and is characterized by extrapulmonary metastasis, including bone metastasis. Bone scans and [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) are widely used for assessment of tumor extension, including vertebral metastasis. However, both methods have a low positive rate with regard to vertebral metastasis arising from myxoid liposarcoma. This is particularly true for bone scans for intramedullary lesions that have no cortical involvement. CASE PRESENTATION: We present the case of a 53-year-old male with myxoid liposarcoma in the leg. He had been treated for multiple metastases over a ten-year period, and was experiencing back pain due to a pathological fracture in the second lumbar vertebra (L2). Magnetic resonance imaging of all the vertebrae showed abnormal signal intensity suggestive of metastasis in eight vertebrae, and revealed extraskeletal extension in three vertebrae. Bone scans and FDG-PET were negative except for the L2 fracture which was indicated on a bone scan. CONCLUSIONS: Both bone scans and FDG-PET can be negative in cases of vertebral metastasis that arise from myxoid liposarcoma, even when extraskeletal extensions are present. Similarly, even a fractured vertebra may not always be visible on FDG-PET.