A herniated disc is a condition in which the nucleus pulposus is displaced from the intervertebral space. It usually leads to back pain, thus being the most common reason for it. Patients often describe the first symptoms of a herniated disc as extreme and decisive pain. Unlike the usual mechanical back pain, a herniated disc is often related to a stinging or burning sensation that often spreads to the lower extremities and proves to be continuous at lower temperatures. We present a case of a 58-year-old male patient who visited the Acibadem City Clinic with complaints of pain initially starting from his hip, which in time extended to his left leg (L5 radiculopathy) and a few days later to his right leg (L5 radiculopathy). Before visiting the clinic, he had been treated in Germany with physiotherapy and supplements, which had proved ineffective. After an MRI, which revealed an L4-L5 herniated disc, he underwent conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) for 14 days in addition to Medrol 4mg tablets (3x1 per day for 10 days). On the third day of the treatment, 60% of the symptoms had subsided. Seven months later, he came in for a scheduled checkup, and 95% of the symptoms were gone. A controlled MRI was done, and the herniated disc had completely vanished. We hope that this type of research will benefit medical professionals, patients, researchers, doctors, and students, among others. Such cases also contribute to the quality of care for such patients and help set regulated factual guidelines regarding their treatment as a whole.

Posterior epidural migration of herniated lumbar disc fragments is a rare pathological entity. This can lead to major neurological deficits. Here, we present a rare case of sequestrated lumbar disc fragment migration into the epidural space. A 49-year-old-man presented with severe low back pain and weakness of the long extensor muscle of the hallux. MRI of the lumbar spine revealed posterior epidural lesion at the L4-L5 level. The disc fragment was isointense on T1 and T2-weighted Images (WI). The mass lesion was removed after decompressive laminectomy. Pathological investigation revealed an intervertebral disc fragment. The patient\'s condition improved postoperatively.

Acute prolapsed inter-vertebral disc (IVDP) is a painful condition that requires immediate treatment by conservative or surgical management. Though majority of patients show remission in symptoms with conservative treatment, regression of herniated disc with non-surgical management has been rarely reported. A 46 years old female patient with acute and severe low back pain, disability and radiating pain towards right lower extremity came to our hospital. Oswestry Disability Index (ODI) score of the patient was 94% indicating bed-ridden condition. MRI of lumbar spine showed diffuse posterior disc bulge between fourth and fifth lumbar vertebra indenting right traversing nerve root and inferior displacement of extruded disc along the body of fifth lumbar vertebra. She was treated according to treatment explained in Ayurveda. She received oral medications, application of medicated oils, fomentation and medicated enema (Basti). After treatment of seven and half months, the patient showed good remission in pain, stiffness and radiculopathy. ODI score reduced to 9% that indicates minimal disability. Follow up MRI showed non significant compression of the nerve root and gross reduction in the inferior displacement of extruded disc. Acute IVDP can be successfully conserved using Ayurveda treatment. The Panchakarma procedures and medicines used in the treatment need further evaluation.

Herniated discs in the lumbar spine are common, however, extraforaminal disc herniations are less frequently encountered. Occasionally, rare disc herniations can mimic other pathologies such as nerve tumor. We present such case and a review of similar cases in the scientific literature. A 71-year-old male who presented with back pain and right-side sciatic pain. Magnetic resonance imaging revealed a fusiform enhancing 3 cm × 2 cm lesion that was concerning for a nerve sheath tumor. A minimally invasive lateral trans-psoas approach was performed for a biopsy that revealed disc fragments and a full resection was performed. The patient\'s symptoms improved at follow-up. Although uncommon, extraforaminal disc herniations can be mistaken for peripheral nerve tumors on imaging. The spine surgeon should remain vigilant about these entities and plan the surgical treatment accordingly.

UNASSIGNED: To describe an unusual case with herniated disc caused by bone cement leaking to disc space after kyphoplasty.
METHODS: We reported a 72-year-old woman with L4 osteoporotic compression fracture. New-onset of left sciatica, numbness and intermittent claudication suffered her immediate after kyphoplasty. Herniated disc caused by bone cement leaking to disc space after kyphoplasty. The patient was post decompressive operation of L34 and the symptoms subsided well then.
UNASSIGNED: Percutaneous vertebroplasty (PVP) was a common procedure today. Especially to back pain caused by osteoporotic fracture, reported pain relief rate was satisfactory. Current studies about bone cement leakage showed kyphoplasty less than vertebroplasty. However, for the mechanism and stress effect of balloon expansion, new weak points and cracks over endplate was created, which may cause bone cement leakage to disc space and related symptoms.
CONCLUSIONS: Kyphoplasty was a common, effective and minimal invasive operation for patients with compression fracture of spine. Cement leakage to intervertebral disc space was generally asymptomatic, but it should be avoided as much as possible. The leakage could affect the stability and weight-bearing of spinal column. Accelerated degenerative process of disc would be found and newly herniated disc would be noted. It should be ceased the procedure when relative amount of bone cement leakage to disc space during kyphoplasty.

UNASSIGNED: Low back pain and lower limb radiculopathy are some of the most common diagnoses in our neurosurgery department. Giant lumbar intervertebral disc herniation, are not a common find in our daily practice. Management for this kind of pathology is controversial. The quest for the best surgical approach is still a matter of debate. This case report intends to demonstrate the advantages of minimally invasive procedures.
METHODS: 40-year-old female, diagnosed with giant lumbar L5-S1 disc herniation with localized lower back electric-type pain, 5/10 intensity in the visual analog scale (VAS) and an Oswestry Disability Index (ODI) score of 76 points, underwent minimally invasive surgery (MIS) with tubular retractor system. 6-month post-op, the patient referred no pain, and an ODI score of 4 points was obtained.
UNASSIGNED: There is no clear classification, regarding the lumbar intervertebral disc herniated content. We didn\'t find any clear indications or contraindications regarding the relationship of the size of herniated disc content and surgical approach (MIS vs Open). We perform on average 175 spine cases per year and educational commitment with spine pathology is demonstrated with our spine fellowship since 3 years ago.
CONCLUSIONS: We believe giant extruded regardless of migration, single-level intervertebral disc herniation, could be effectively and safely treated by MIS.

A 31-year-old man with mild hemophilia B developed a herniated disc treated with prednisolone for back pain. Surprisingly, hemostasis result tests performed before epidural infiltration were a normal activated partial thrombin time at 36.1 s. (normal range 27.9-37.7 s.) and factor IX (FIX) level 76% (normal range>70%), 13 days after prednisolone introduction. After a second control with a normal FIX level and a second genetic confirmation of hemophilia, no FIX concentrates was administered to perform the infiltration, which occurred without hemorrhagic complication. This new case of FIX normalization showed the necessity to have a perfect knowledge of patient\'s treatment to avoid misdiagnosis and a temporary normal hemostasis permit to perform epidural infiltration without replacement therapy.

Stroke is generally considered to be the first preliminary diagnosis in patients presenting with acute hemiparesia in the emergency department. But rarely in unexpected spontaneous neurological pathologies that may lead to hemiparesis. The data from 8 non-traumatic patients who underwent surgical treatment for brown-sequard syndrome (BSS) were reviewed retrospectively. All patients were initially misdiagnosed with strokes. Two of the patients had spinal canal stenosis, two had spinal epidural hematomas, one had an ossified herniated disc and three had soft herniated discs. None of the patients complained of significant pain at the initial presentation. All of the patients had a mild sensory deficit that was initially unrecognized. The pain of the patients began to become evident after hospitalization and, patients transferred to neurosurgery department. Cervical spinal pathologies compressing the corticospinal tract in one-half of the cervical spinal canal may present with only hemiparesis, without neck and radicular pain. If it\'s too late, permanent neurological damage may become inevitable while it is a correctable pathology.

Lumbar disc herniation is common and may be symptomatic. The magnetic resonance imaging (MRI) scan is an appropriate tool to confirm the diagnosis and affected level of the spine. While a disc herniation is usually associated with ipsilateral symptoms, a few cases have been reported to present with contralateral symptoms. We report a unique case of left lumbar disc herniation at L5/S1 who presented with contralateral symptoms and was successfully treated with a right L5/S1 foraminal block. However, the patient developed concordant ipsilateral symptoms 6 weeks later and was treated with left L5/S1 microdiscectomy.

BACKGROUND: Herniated thoracic intervertebral disc is a rare cause of spinal cord compression. Its frequency varies from 0.15% to 1.7% of all disc herniations, and produces symptoms in 0.5% to 0.8%.
METHODS: Case 1. A 50-year-old woman, with pain and burning sensation in left hemithorax of four months of onset. It was treated as a herpetic syndrome, with no improvement. She was seen after thirteen days of exacerbation of clinical symptoms. The physical examination showed asymmetric paraparesis, lower left pelvic limb 1/5, and right pelvic limb 3/5¸ sensory level T8, with left Babinski positive. A thoracic disc herniation in space T8-T9 was diagnosed.
METHODS: A 55-year-old patient with a history of presenting pain in lumbar area of 5 years onset. She also had radicular pain that radiated to the right pelvic limb, with intensity 10/10 on a Visual Analogue Scale. Her physical examination showed muscle strength 5/5, with normal sensitivity in all dermatomes and tendon reflexes, and a positive right Babinski. Thoracic disc herniation T7-T8 level was diagnosed.
CONCLUSIONS: Due to anatomical conditions that define this type of hernia, the extracavitary posterolateral approach should be the recommended surgical procedure when the simultaneously performed anterior decompression and fixation with posterior instrumentation are the treatments proposed.
CONCLUSIONS: Despite the different anatomical structures of this special area, it was possible to obtain satisfactory results for both clinical cases.