Surgical management of tumor-mimicking posteriorly migrated lumbar disc fragment using a quadrant minimally invasive approach: a case report and literature review.

BACKGROUND

Posterior epidural migration of disc fragments (PEMDF) is a rare condition that can mimic spinal tumors on imaging, particularly neurogenic lesions, thereby posing a diagnostic challenge preoperatively. Owing to its atypical posterior extradural location and characteristic contrast enhancement patterns, it is frequently misinterpreted as a neoplastic process. Previous studies have reported that such lesions are commonly managed with open posterior decompression or conventional laminectomy to establish a definitive diagnosis and relieve neural compression. However, reports describing minimally invasive management, particularly the Quadrant approach, remains sacrce. Herein, we present this case to emphasize the diagnostic pitfalls and to demonstrate the feasibility of minimally invasive surgical treatment.

CASE PRESENTATION: A 67-year-old man presented with a 6-month history of intermittent low back pain, accompanied by progressively worsening bilateral lower-extremity numbness and weakness. Magnetic resonance imaging demonstrated a posterior extradural mass at the L2/3 level, characterized by heterogeneous hyperintensity on T2-weighted images and peripheral rim enhancement following contrast administration. A neurogenic tumor was initially suspected based on these findings. Given the progressive neurological deterioration and diagnostic uncertainty, the patient underwent surgical intervention via a minimally invasive Quadrant approach, achieving complete excision of the lesion. Histopathological examination revealed findings consistent with degenerative intervertebral disc tissue. Postoperatively, the patient showed marked symptomatic improvement, with complete recovery of lower-extremity muscle strength. No neurological deficits or radiological recurrence were observed during the 6-month follow-up period.

CONCLUSIONS

PEMDF can closely mimic spinal tumors on magnetic resonance imaging, particularly when peripheral rim enhancement and posterior extradural localization are observed. Awareness of this entity is essential to prevent misdiagnosis. While surgical treatment has traditionally relied on open decompression for both diagnostic confirmation and symptom relief, minimally invasive approaches such as the Quadrant technique, may provide an effective alternative in selected cases. Surgical exploration remains a reliable approach for establishing a definitive diagnosis and providing treatment when imaging findings are inconclusive.