CASE REPORT
Micro Endoscopic Discectomy for Cranially Migrated L1–L2 Sequestered Disc Herniation
Micro Endoscopic Discectomy for Cranially Migrated L1–L2 Sequestered Disc Herniation
Minimally invasive removal of a sequestered L1–L2 disc fragment that closely resembled a neurogenic tumour on imaging, using an 18 mm tubular micro endoscopic approach.
L1–L2
Upper lumbar level affected
Pain-free
Excellent recovery following surgery
18 mm Tubular Approach
Micro endoscopic discectomy performed
Sequestered Disc
Cranially migrated disc fragment causing nerve compression
Clinical history
The patient presented with persistent lower back pain and symptoms suggestive of upper lumbar nerve compression. Radiological evaluation revealed an unusual lesion at the L1–L2 level. The appearance closely resembled a neurogenic tumour, making the diagnosis more challenging than a typical lumbar disc herniation.
A detailed clinical assessment and careful review of the imaging were undertaken to determine the exact nature of the lesion before planning surgery.
Further evaluation confirmed that the lesion represented a sequestered lumbar disc fragment that had migrated cranially from the L1–L2 intervertebral disc space. The migrated fragment was compressing the adjacent neural structures, accounting for the patient's symptoms.
Recognising this uncommon pattern was essential for selecting the appropriate surgical treatment and avoiding unnecessary procedures intended for spinal tumours.
Dr. Rohit Thaker performed a micro endoscopic discectomy using an 18 mm tubular approach. This minimally invasive technique provided direct access to the migrated disc fragment while preserving the surrounding muscles, ligaments, and normal spinal anatomy.
The tubular approach allowed precise visualisation of the affected area through a small incision with minimal soft tissue disruption.
The cranially migrated sequestered disc fragment was completely excised, and the compressed neural structures were carefully decompressed. Particular attention was given to ensuring complete removal of the migrated fragment while protecting the surrounding nerves.
Adequate decompression was confirmed before completing the procedure.
The patient recovered smoothly after surgery and was able to begin mobilisation early. As healing progressed, pain steadily improved, allowing a gradual return to normal daily activities.
Outcome
Following surgery, the patient’s symptoms resolved completely. The patient is pain-free, neurologically stable, and continues to do well on clinical follow-up after successful removal of the migrated disc fragment.
Cause and clinical significance
Sequestered lumbar disc herniations occur when a fragment of the intervertebral disc separates completely from the parent disc and migrates away from its original position. Cranial migration at the L1–L2 level is uncommon and can occasionally resemble a neurogenic tumour on MRI because of its location and imaging characteristics. Accurate interpretation of clinical findings together with imaging is therefore essential to establish the correct diagnosis.
Micro endoscopic discectomy provides an effective option for treating selected cases of migrated lumbar disc herniation. Through a small tubular corridor, the offending disc fragment can be removed while preserving healthy tissues, achieving effective neural decompression and supporting a quicker functional recovery.