Zhou JG. Diagnosis and surgical challenges of extremely severe head and lumbar disc herniation in young patients: A case report. World J Clin Cases 2025; 13(16): 103373 [DOI: 10.12998/wjcc.v13.i16.103373]
Corresponding Author of This Article
Jun-Ge Zhou, Department of Neurosurgery, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, No. 5 Huiji Road, Jiangan District, Wuhan 430010, Hubei Province, China. 43494830@qq.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Diagnosis and surgical challenges of extremely severe head and lumbar disc herniation in young patients: A case report
Jun-Ge Zhou
Jun-Ge Zhou, Department of Neurosurgery, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, Wuhan 430010, Hubei Province, China
Author contributions: Zhou JG comprehensively designed and executed the research project detailed in this manuscript, encompassing all aspects from conception, data collection, literature review, to the drafting and revision of the manuscript. Zhou JG bears full responsibility for the content and accuracy of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Ge Zhou, Department of Neurosurgery, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, No. 5 Huiji Road, Jiangan District, Wuhan 430010, Hubei Province, China. 43494830@qq.com
Received: November 20, 2024 Revised: December 30, 2024 Accepted: January 17, 2025 Published online: June 6, 2025 Processing time: 82 Days and 6.6 Hours
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.
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.
