Traumatic lumbar disc herniation mimicking epidural hematoma: A case report and literature review

RATIONALE: We report a rare case of traumatic lumbar disc herniation mimicking epidural hematoma. PATIENT CONCERNS: A 39-year old man presented with acute bilateral leg and back pain, following a crushing injury caused by a crane collapse. DIAGNOSIS: A computed tomography scan revealed multiple compression fractures of the thoracolumbar spine, including a burst fracture of the L4 vertebral body. Magnetic resonance imaging (MRI) showed an epidural mass, extending longitudinally and causing dural sac compression behind the L3 vertebra. The mass had isosignal intensity on T1-weighted imaging and showed mixed high and low signals on T2-weighted imaging. On the basis of the patient's clinical history and imaging findings, our provisional diagnosis was an epidural hematoma following major trauma. INTERVENTIONS: An emergency L3 laminectomy was performed with percutaneous screw fixation of L3-5. Intraoperatively, 3 large herniated disc fragments were found at L3 with no evidence of hematoma. OUTCOMES: The patient recovered normal motor function after surgery. At the last follow-up, 3 years after surgery, there was no residual neurological deficit apart from intermittent lower back pain. LESSONS: In cases where MRI findings reveal an epidural lesion with a longitudinal shape, similar to an epidural hematoma, with mixed signal intensity on T2-weighted images and high peripheral signal intensity on T1-weighted images, traumatic disc herniation should be included in the differential diagnosis.