Retropulsion of Ruptured Nucleus Pulposus Simulating Tumor of the Cauda Equina

Abstract

During the past three years at the Cleveland Clinic more than sixty patients, whose preoperative diagnosis was ruptured intervertebral disc, have revealed such a lesion at operation. In all but two of these cases the lesion occurred in the lumbar spine. It usually was situated on one side only, impinging on a single nerve root, and causing low back pain with radiation into one leg. The clinical impression was confirmed in each case by contrast myelography before resorting to operation. In only one case, the subject of this report, was a definite preoperative diagnosis of tumor of the cauda equina made and firmly adhered to until laminectomy revealed a large ruptured fragment of the nucleus pulposus of the intervertebral disc between the third and fourth lumbar vertebrae. Because of the interesting and confusing characteristics of this case, it is reported below.

Case Report

History: A married white woman, thirty-five years of age, first noticed pain in the lumbar spine and in both hips five or six years previously. The pain occurred most frequently while the patient was in the sitting position. It was intermittent, recurring at intervals. Following the birth of a baby eighteen months prior to examination, there was a marked exacerbation of pain in the lower back and in both hips, with aggravation of the pain on coughing and sneezing. For six months prior to examination the symptoms gradually became more troublesome. During the last six weeks the pain became severe and was accompanied by marked weakness of. . .