Lumbar disc sequestration mimicking a tumor: Report of four cases and a literature review

Table 1 Summary of disc herniation cases that mimicked tumors

Ref.	Age (yr), Sex	Symptoms	Duration of symptoms	Level	Location of disc fragments	Preoperative imaging	Gadolinium enhanced MRI	Preliminary diagnosis	Treatment	Outcome
Emamian et al[6], 1993	49, Female	Left-sided sciatica	Note report	L4-5	Left intervertebral foramen	CT, My, MRI	Peripheral enhancement	Neurilemmoma	H + R	Partial recovery
Cusimano et al[22], 1995	42, Male	Left leg pain and paresthesia	Note report	L3-4	Lateral to the left intervertebral foramen	CT, MRI	Enhancement	Neurilemmoma	Surgery (lateral intermuscular approach)	Partial recovery
Ashkenazi et al[7], 1997	59, Male	Pain in the lower back and right leg	6 mo	L3-4	Right intervertebral foramen	X-ray, CT, MRI	Remarkably enhanced	Neurilemmoma	H + R	Recovery
Saruhashi et al[11], 1999	44, Female	Pain in the lower back, right buttock, and leg	1 mo	L5 vertebral body	Right posterior epidural space	X-ray, CT, My, MRI	Peripheral enhancement	Dumbbell tumor	L + R	Recovery
Bose[12], 2003	54, Male	Weakness and numbness in both lower limbs	5 yr	T11-12	Left posterior epidural space	MRI	Considerable peripheral enhancement	Neoplasm	L + R	Recovery
Aydin et al[13], 2004	58, Male	Pain in the low back and right leg	2 yr, exacerbation of symptoms for 5 d	L5-S1	Posterior intradural extra-medullary	MRI	Peripheral enhancement	Spinal tumor	L + R	Recovery
Lee and Suh[3],2006	61, Male	Pain in the low back and both lower legs	4 mo, exacerbation of symptoms for 3 d	L5-S1	Posterior intradural extra-medullary	MRI	Peripheral enhancement	Spinal tumor	L + R	Recovery
Bakar et al[18], 2009	46, Female	Pain in the low back and right leg	1 mo	L4-5	Lateral to the right intervertebral foramen	MRI	Enhanced homogenously	Nerve root neurilemmoma	H + R	Recovery
Stavrinou et al[4], 2009	46, Female	Neck pain and right brachialgia, weakness and numbness in the right hand	3 wk	C5-6	Right anterior epidural space	MRI	Enhanced homogenously	Neurilemmoma	Conservative	Recovery
Eksi et al[14], 2010	76, Female	Pain and weakness in the left foot	1 mo	S1 vertebral body	Retroperitoneal left pre-sacral	MRI	Note report	Neurilemmoma	Surgery (anterior retroperitoneal approach)	Partial recovery
Levene et al[23], 2010	53, Female	Pain in the low back and numbness in the right leg	3 wk	L2 vertebral body	Right anterior epidural space	X-ray, MRI	Peripheral enhancement	Cartilage neoplasm	Note report	Note report
Hoch and Hermann[1], 2010	50, Male	Pain in the low back and both lower legs	4 mo, exacerbation of symptoms for 20 d	L3-4	Right posterior epidural space	MRI	Peripheral ring enhancement	Spinal tumor	L + R	Recovery
Liu et al[15], 2011	50, Female	Pain in the low back, both hips, and left leg, numbness of both legs	6 mo, exacerbation of symptoms for 2 wk	L5 vertebral body	Anterior intra-dural extra-medullary	MRI	Peripheral ring enhancement	Intraspinal tumor	L + R	Recovery
Demirci and Er[16], 2011	53, Female	Pain in the low back and both lower legs	10 yr, exacerbation of symptoms for 15 d	L2-3	Posterior intra-dural extramedullary	MRI	Enhanced homogenously	Spinal tumor	L + R	Recovery
Sharma et al[19], 2012	55, Male	Pain and weakness in the right leg	2 mo	S1 vertebral body	Retroperitoneal right pre-sacral	CT, MRI	Peripheral enhancement	Neurilemmoma	Surgery (anterior retroperitoneal approach)	Recovery
Song et al[8], 2012	50, Female	Upper back pain and intermittent abdominal discomfort	3 mo	T6-7	Left intervertebral foramen	X-ray, CT, MRI	Peripheral enhancement	Bony tumor of the spinal canal	H + R	Recovery
Pillai[24], 2012	51, Male	Low backache with radiating pain to the right lower limb	45 d	S1	Intra-radicular in the right root	MRI	No enhancement	Nerve root tumor	H + R	Recovery
Dimogerontas et al[9], 2012	56, Male	Low back pain and right sciatica	12 mo, exacerbation of symptoms for 4 d	L1-4	Right anterior epidural space	MRI	Peripheral ring enhancement	Spinal tumor	L + R	Recovery
Peng and Pang[25], 2013	49, Male	Pain and numbness in the right leg	1 yr, exacerbation of symptoms for 10 d	L5 vertebral body	Epidural space	MRI	Note report	Note report	H + R	Recovery
Li et al[2], 2016	48, Male	Intermittent pain in the low back and left lower limb and frequent urination	4 yr, exacerbation of symptoms for 1 mo	L5-S1	Left posterior epidural space	X-ray, CT, MRI	Peripheral ring enhancement	Extra-dural spinal tumor	L + R	Partial recovery
Ajayi et al[17], 2016	65, Female	Pain in the lower back and bilateral legs, weakness, and numbness in both legs	1 mo, exacerbation of the symptoms for 2 wk	L3-4	Left posterior epidural space	MRI	Peripheral ring enhancement	Spinal tumor	L + R	Recovery
Jia et al[10], 2018	57, Male	Low back pain, pain, and hypoesthesia in the right leg	10 yr, exacerbation of symptoms for 1-mo	L4 vertebral body	Right anterior epidural space	MRI, 3D MRI	Note report	Neurilemmoma	Surgery	Recovery
	63, Male	Back pain and radiating pain in the right leg	3 mo	L3-4	Lateral recess	MRI, 3D MRI	Heterogeneous peripheral ring enhancement	Neurilemmoma	Minimally invasive endoscopic surgery	Recovery
Ozpeynirci et al[26], 2019	42, Male	Right-sided radicular leg pain	1 mo	L5-S1	Retroperitoneal right pre-sacral	CT, MRI	Peripheral enhancement	Retroperitoneal peripheral neurilemmoma	Surgery (abdominal laparotomy)	Partial recovery
Present case one	71, Male	Low back pain and radiating pain in the left leg	1 yr, exacerbation of symptoms for 2 wk	L4 vertebral body	Left posterior epidural space	X-ray, MRI	Heterogeneous enhancement	Neurilemmoma	L + D + R	Recovery
Present case two	74, Male	Pain in both knees with limited movement	3 yr, exacerbation of symptoms for 3 wk	L4-5	Right posterior epidural space	X-ray, CT, MRI	Heterogeneous peripheral ring enhancement	Neurilemmoma	L + D + R	Recovery
Present case three	53, Male	Numbness and weakness in the low back and right lower limb	2 wk	L4-5	Right anterior epidural space	X-ray, CT, MRI	Considerable peripheral enhancement	Spinal tumor	L + D + R	Recovery
Present case four	75, Male	Right-sided radicular leg pain	15 d, exacerbation of symptoms for 1 wk	L3 vertebral body	Right anterior epidural space	X-ray, CT, MRI	No obvious enhancement	Spinal tumor	H + D + R	Recovery

L: Laminectomy; D: Discectomy; H: Hemilaminectomy; R: Removal of the mass; X-ray: Plain radiographs; CT: Computed tomography; My: Myelography; MRI: Magnetic resonance imaging.