Posterior epidural disc migration is a very unusual event. Cauda equina syndrome resulting from a posterior epidural disc migration is also quite uncommon. Diagnosis of a posterior migrated disc fragment can be easily made by magnetic resonance imaging. In this report, a patient is described who presented with acute cauda equina syndrome after a massage with hot water. An immediate MRI revealed L2–3 disc herniation with posterior epidural disc migration. A decompressive total L2 laminectomy was immediately performed, and two unattached disc fragments were observed and removed just underneath the lamina. The patient was free of pain postoperatively. After 12 months, the patient had slight paraparesis and urinary incontinence. Diagnosis of a posterior migrated disc fragment with magnetic resonance imaging is very favorable, although cases have been reported where migrated disc fragments were not seen by magnetic resonance imaging. Neurosurgeons should keep this unique situation in mind, especially in symptomatic cases.
Keywords: Cauda equina syndrome, epidural lumbar disc herniation, magnetic resonance imaging, massage, sequestrated lumbar disc