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Most of the back pains are improved by back exercises.. "/> <meta name="citation_publisher" content="International Online Medical Council (IOMC)"/> <meta name="citation_journal_title" content="Journal of Neurology & Neurophysiology"> <meta name="citation_title" content="Posterior Epidural Lumber Disc Migration Presenting As An Epidural Mass:-A Rare Case Report With Diagnostic Dilemma"> <meta name="citation_author" content="Shrish Nalin1"/> <meta name="citation_author" content="Kanika Gupta2"/> <meta name="citation_author" content="Amit joshi3"/> <meta name="citation_author" content="Mukesh kumar4"/> <meta name="citation_year" content="2022"> <meta name="citation_volume" content="13"> <meta name="citation_issue" content="8"> <meta name="citation_doi" content="10.35248/2471-268X.22.13.8.594"> <meta name="citation_issn" content="2155-9562"> <meta name="citation_publication_date" content="2022/08/31"/> <meta name="citation_firstpage" content="1"> <meta name="citation_lastpage" content="2"> <meta name="citation_abstract" content="Back pain is one of the most common complaints of patients presenting in the Neurosurgery Department. Most of the back pains are improved by back exercises, analgesics and requires no specific investigation. But sometimes patients present with severe signs and symptoms of back pain with cauda equina syndrome for which immediate diagnosis and management is required. In back pain with cauda equina syndrome to diagnose the cause, investigation of choice following clinical examination is a MRI lumbosacral spine. In Neurosurgery herniated lumbar disc is one of the most common cause of low back pain with CES and easily diagnosed over MRI lumbosacral spine. But sometimes imaging increases the confusion regarding diagnosis. We hereby report a patient with severe LBP (low back pain)with bilateral lower limbs radiculopathy who presented with a lumber epidural mass which later turn out to be a posterior epidural migrated lumber disc fragment (PDF).Back pain is one of the most common complaints of patients presenting in the Neurosurgery Department. Most of the back pains are improved by back exercises, analgesics and requires no specific investigation. But sometimes patients present with severe signs and symptoms of back pain with cauda equina syndrome for which immediate diagnosis and management is required. In back pain with cauda equina syndrome to diagnose the cause, investigation of choice following clinical examination is a MRI lumbosacral spine. In Neurosurgery herniated lumbar disc is one of the most common cause of low back pain with CES and easily diagnosed over MRI lumbosacral spine. But sometimes imaging increases the confusion regarding diagnosis. We hereby report a patient with severe LBP (low back pain)with bilateral lower limbs radiculopathy who presented with a lumber epidural mass which later turn out to be a posterior epidural migrated lumber disc fragment (PDF)."> <meta name="citation_fulltext_html_url" content="https://www.iomcworld.org/open-access/posterior-epidural-lumber-disc-migration-presenting-as-an-epidural-massa-rare-case-report-with-diagnostic-dilemma-96006.html"> <meta name="citation_pdf_url" content="https://www.iomcworld.org/open-access/posterior-epidural--lumber-disc-migration-presenting-as-an-epidural-massa-rare-case-report-with-diagnostic-dilemma.pdf"> <meta name="citation_abstract_html_url" content="https://www.iomcworld.org/abstract/posterior-epidural-lumber-disc-migration-presenting-as-an-epidural-massa-rare-case-report-with-diagnostic-dilemma-96006.html"> <script type="text/javascript"> function openimage( theURL, winName, features ) { window.open( theURL, winName, features ); } </script> </head> <body>  <header>  <div class="bg-1"> <div class="container-fluid py-1"> <div class="row justify-content-between align-items-center"> <div class="col-sm-auto"> <a href="https://www.iomcworld.org/" title="IOMC"><img src="/assets/img/IOMC-logo-white.svg" alt="jnn" height="50" alt="IOMC"></a> </div> <div class="col-sm-auto"> <nav class="nav"> <a class="nav-link white"><i class="fa fa-whatsapp"></i> +1-845-458-6882 </a> <a href="mailto:submissions@iomcworld.org" class="nav-link white"><i class="fas fa-envelope-square"></i> submissions@iomcworld.org</a> <a href="https://www.scholarscentral.org/submissions/neurology-neurophysiology.html" title="Submit Manuscript" class="btn bg-yellow-100">Submit Manuscript</a> <div id="google_translate_element"></div> </nav> </div> </div> </div> </div>  <div class="py-3"> <div class="container-fluid"> <div class="row align-items-center justify-content-between"> <div class="col-12 col-sm-auto"> <h1 class="rockwell fweight-600 mb-0">Journal of Neurology & Neurophysiology</h1> <span class="float-right">ISSN - 2155-9562 </span> </div> </div> </div> </div>  <nav class="navbar navbar-expand-lg navbar-dark bg-1"> <a class="navbar-brand d-none" href="#">Navbar</a> <button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#navbarJrnl" aria-controls="navbarJrnl" aria-expanded="false" aria-label="Toggle navigation"> <span class="navbar-toggler-icon"></span> </button> <div class="collapse navbar-collapse justify-content-between" id="navbarJrnl"> <ul class="navbar-nav"> <li class="nav-item"> <a class="nav-link active" href="https://www.iomcworld.org/neurology-neurophysiology.html" title="Journal Home">Journal Home</a> </li> <li class="nav-item"> <a class="nav-link" href="https://www.iomcworld.org/neurology-neurophysiology/editorial-board.html" title="Editorial Board">Editorial Board</a> </li> <li class="nav-item dropdown"> <a class="nav-link custom-toggle" href="#" id="navbarDropdownMenuLink" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Author Guidelines <i class="fa fa-angle-down align-middle" aria-hidden="true"></i> </a>  <div class="dropdown-menu custom-dropdown" aria-labelledby="navbarDropdownMenuLink"> <a class="dropdown-item" href="https://www.iomcworld.org/neurology-neurophysiology/aims-and-scope.html">Aim & Scope</a> <a class="dropdown-item" href="https://www.iomcworld.org/neurology-neurophysiology/instructionsforauthors.html">Instruction For Authors</a> <a class="dropdown-item" href="https://www.iomcworld.org/neurology-neurophysiology/guidelines.html">Author Guidelines</a> <a class="dropdown-item" href="https://www.iomcworld.org/neurology-neurophysiology/peer-review-process.html">Peer Review Process</a> <a class="dropdown-item" href="https://www.iomcworld.org/neurology-neurophysiology/ethical-malpractices.html">Publication Ethics & Malpractice Statement</a> </div> </li> <li class="nav-item"> <a class="nav-link" href="https://www.iomcworld.org/neurology-neurophysiology/inpress.html" title="Articles in process">Articles in process</a> </li>  <li class="nav-item"> <a class="nav-link" href="https://www.iomcworld.org/neurology-neurophysiology/archive.html" title="Archive">Archive</a> </li> <li class="nav-item"> <a class="nav-link" href="https://www.iomcworld.org/neurology-neurophysiology/submit-manuscript.html" title="Submit Manuscript">Submit Manuscript</a> </li> <li class="nav-item"> <a class="nav-link" href="https://www.iomcworld.org/neurology-neurophysiology/contact.html" title="Journal Contact">Journal Contact</a> </li> </ul>  </div> </nav>   </header> <script type="text/javascript"> function googleTranslateElementInit() { new google.translate.TranslateElement({pageLanguage: 'en'}, 'google_translate_element'); } </script> <script type="text/javascript" src="//translate.google.com/translate_a/element.js?cb=googleTranslateElementInit"></script> <section class="py-4 content"> <div class="container"> <div class="row"> <div class="col-12 col-sm-9 full-text"> <div class="row align-items-center justify-content-between"> <div class="col-12 col-sm-auto"> <p class="text-muted mb-0"> Case Report - (2022) Volume 13, Issue 8 </p> </div> <div class="col-12 col-sm-4 text-right"> <a href="https://www.iomcworld.org/open-access/posterior-epidural--lumber-disc-migration-presenting-as-an-epidural-massa-rare-case-report-with-diagnostic-dilemma.pdf" title="View PDF" class="btn btn-sm bg-green-600 rounded-50"><i class="fas fa-file-pdf"></i> View PDF</a> <a href="https://www.iomcworld.org/pdfdownload.php?download=open-access/posterior-epidural--lumber-disc-migration-presenting-as-an-epidural-massa-rare-case-report-with-diagnostic-dilemma.pdf&aid=96006" title="Download PDF" class="btn btn-sm bg-green-600 rounded-50"><i class="fas fa-download"></i> Download PDF</a> </div> </div>  <h2 class="font-size-7 mt-2">Posterior Epidural Lumber Disc Migration Presenting As An Epidural Mass:-A Rare Case Report With Diagnostic Dilemma</h2> <a href='https://www.iomcworld.org/author/shrish-nalin-48681' title='Shrish Nalin' style='color:#555; border-bottom:1px dotted #CCC;'>Shrish Nalin</a><sup><a href='#a1'>1</a></sup><sup><a href='#Shrish_Nalin'>*</a></sup>, <a href='https://www.iomcworld.org/author/kanika-gupta-48682' title='Kanika Gupta' style='color:#555; border-bottom:1px dotted #CCC;'>Kanika Gupta</a><sup><a href='#a2'>2</a></sup>, <a href='https://www.iomcworld.org/author/amit-joshi-48683' title='Amit joshi' style='color:#555; border-bottom:1px dotted #CCC;'>Amit joshi</a><sup><a href='#a3'>3</a></sup> and <a href='https://www.iomcworld.org/author/mukesh-kumar-48914' title='Mukesh kumar' style='color:#555; border-bottom:1px dotted #CCC;'>Mukesh kumar</a><sup><a href='#a3'>3</a></sup> <div> </div> <a id="Shrish_Nalin"></a> <strong><sup>*</sup>Correspondence:</strong> Shrish Nalin, Department of neurosurgery Dr.RPGMC Tanda, Kangra (H.P.), India, <strong>Email:</strong> <i class='fa fa-envelope' aria-hidden='true' title='nalinshrish@yahoo.com'></i> <p><a href="#ai"><strong>Author info »</strong></a></p> <div class="card bg-light mb-3"> <div class="card-body px-3 pb-0"> <h2 class="font-size-5">Abstract</h2> <p>Back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> is one of the most common complaints of patients presenting in the <a target='_blank' href='https://www.iomcworld.org/medical-journals/neurosurgery-2696.html'>Neurosurgery</a> Department. Most of the back pains are improved by back exercises, analgesics and requires no specific investigation. But sometimes patients present with severe signs and symptoms of back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> with cauda equina syndrome for which immediate diagnosis and <a target='_blank' href='https://www.iomcworld.org/medical-journals/management-22652.html'>management</a> is required. In back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> with cauda equina syndrome to diagnose the cause, <a target='_blank' href='https://www.iomcworld.org/medical-journals/investigation-46257.html'>investigation</a> of choice following clinical examination is a MRI lumbosacral spine. In <a target='_blank' href='https://www.iomcworld.org/medical-journals/neurosurgery-2696.html'>Neurosurgery</a> herniated lumbar disc is one of the most common cause of low back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> with CES and easily diagnosed over MRI lumbosacral spine. But sometimes imaging increases the confusion regarding diagnosis. We hereby report a patient with severe LBP (low back pain)with bilateral lower limbs radiculopathy who presented with a lumber epidural mass which later turn out to be a posterior epidural migrated lumber disc fragment (PDF).Back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> is one of the most common complaints of patients presenting in the <a target='_blank' href='https://www.iomcworld.org/medical-journals/neurosurgery-2696.html'>Neurosurgery</a> Department. Most of the back pains are improved by back exercises, analgesics and requires no specific investigation. But sometimes patients present with severe signs and symptoms of back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> with cauda equina syndrome for which immediate diagnosis and <a target='_blank' href='https://www.iomcworld.org/medical-journals/management-22652.html'>management</a> is required. In back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> with cauda equina syndrome to diagnose the cause, <a target='_blank' href='https://www.iomcworld.org/medical-journals/investigation-46257.html'>investigation</a> of choice following clinical examination is a MRI lumbosacral spine. In <a target='_blank' href='https://www.iomcworld.org/medical-journals/neurosurgery-2696.html'>Neurosurgery</a> herniated lumbar disc is one of the most common cause of low back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> with CES and easily diagnosed over MRI lumbosacral spine. But sometimes imaging increases the confusion regarding diagnosis. We hereby report a patient with severe LBP (low back pain)with bilateral lower limbs radiculopathy who presented with a lumber epidural mass which later turn out to be a posterior epidural migrated lumber disc fragment (PDF).</p> <h4 class="font-size-4">Keywords</h4> <p>Low Back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>Pain</a> • Posterior Epidural Migrated Disc Fragment • Epidural Mass</p> </div> </div> <h4>Case Description</h4> <p>A 45 -year old man had visited the <a target='_blank' href='https://www.iomcworld.org/medical-journals/neurosurgery-2696.html'>neurosurgery</a> opd with complaints of having low back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> for two years which was more on standing and walking. The patient used to take over-the-counter analgesics for <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> relief and never had a formal checkup. But for the last one week Low Back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>Pain</a> (LBP) was severe with a Visual Analogue Score (VAS) score is around 8 and <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> radiating to both legs. The patient had difficulty in standing and walking although power was intact in lower limbs. He also had increased frequency of micturition for last week but no urinary incontinence. He had no <a target='_blank' href='https://www.iomcworld.org/medical-journals/history-41693.html'>history</a> of trauma. The patient had bilateral hypoesthesia in the L4-L5 region. The blood tests revealed no alterations. After a thorough neurological examination patient was advised urgent MRI thoracolumbosacral spine with contrast.MRI revealed a wide lesion in the L4-5 epidural space with compression of the epidural sac at the L4-5 level <strong>(Figures 1 and 2).</strong></p> <p><a class="thumbnail" onclick="openimage('https://www.iomcworld.org/articles-images-2021/ldjnn-13-8-005-g001.png','','scrollbars=yes,resizable=yes,width=500,height=330')"> <img alt="ldjnn-13-8-005-g001" class="img-thumbnail img-fluid d-block mx-auto" src="https://www.iomcworld.org/articles-images-2021/ldjnn-13-8-005-g001.png" title="ldjnn-13-8-005-g001" /> </a></p> <p><strong>Figure 1:</strong> MRI sagittal view lumbosacral spine T2 image showing a well defined round epidural mass compressing over l4,l5 level thecal sac.</p> <p><a class="thumbnail" onclick="openimage('https://www.iomcworld.org/articles-images-2021/ldjnn-13-8-005-g002.png','','scrollbars=yes,resizable=yes,width=500,height=330')"> <img alt="ldjnn-13-8-005-g002" class="img-thumbnail img-fluid d-block mx-auto" src="https://www.iomcworld.org/articles-images-2021/ldjnn-13-8-005-g002.png" title="ldjnn-13-8-005-g002" /> </a></p> <p><strong>Figure 2:</strong> MRI l4,l5 level axial T2 cut showing.</p> <p>The patient was planned for emergency <a target='_blank' href='https://www.iomcworld.org/medical-journals/surgery-2642.html'>surgery</a> given developing Cauda Equina symptoms.A posterior midline incision extending from L2 to S1 was given. Paravertebral muscles were separated with the help of monopolar cautery and then self-retaining retractors were applied.L4 laminectomy is done initially in accordance with the MRI imaging but there was no epidural mass was found.L4-5 disc space was identified under C arm guidance which was empty. Then L3 laminectomy was also done. And a well-defined lobulated mass was found on the left side of the thecal sacafter removing the ligamentum flavum which had compressed the thecal sac <strong>(Figure 3).</strong></p> <p><a class="thumbnail" onclick="openimage('https://www.iomcworld.org/articles-images-2021/ldjnn-13-8-005-g003.png','','scrollbars=yes,resizable=yes,width=500,height=330')"> <img alt="ldjnn-13-8-005-g003" class="img-thumbnail img-fluid d-block mx-auto" src="https://www.iomcworld.org/articles-images-2021/ldjnn-13-8-005-g003.png" title="ldjnn-13-8-005-g003" /> </a></p> <p><strong>Figure 3:</strong> Posterior epidural disc migration 1</p> <p>Cruciate incision with 11 number knife was given and then with the help of disc forceps this lobulated mass was emptied which turn out to be an epidural migrated disc which used to be a very rare phenomenon.</p> <p>On the first post-operative day, the patient had good <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> relief (VAS back 3) and showed prompt neurological recovery. The patient was discharged five days after <a target='_blank' href='https://www.iomcworld.org/medical-journals/surgery-2642.html'>surgery</a> and at the one-month follow-up evaluation, he was pain-free, with no hypoesthesia or motor weakness.</p> <h4>Discussion</h4> <p>The first case of a Disc Herniation(DH) with posterior epidural migration(PEM) was reported by Lichtor in 1989 which is also known as Posterior Epidural Migration Of Lumber Disc Fragment(PEMLDF) and till now only 75 cases have been reported [<a href="#1" title="1">1</a>]. DH is a displacement of disc material beyond the limits of the intervertebral disc space [<a href="#2" title="2">2</a>-<a href="#3" title="3">3</a>].</p> <p>According to the shape, DH can be classified as protrusions or extrusions. sequestration is a type of disc extrusion in which the disc has lost its continuity with the native disc. DH may also be categorized as contained or uncontained, whether these are covered or not by the annulus fibrosus [<a href="#4" title="4">4</a>]. In relation to the dural sac, DH is commonly located anteriorly or antero-laterally [<a href="#5" title="5">5</a>]. In a series of 2880 patients operated for lumbar DH, Sengoz et al. reported an incidence of 0.27%. In their series, the migrated fragments were located mainly at the L3-4 level (75%) and the L4-5 (25%) [<a href="#6" title="6">6</a>]. Disc herniation in the lumber region is although very common but there are various structures that prevents its migration to the posterior epidural space which consists of- the posterior longitudinal ligament, annulus Fibrosus, septum posticum., A fibrous lateral (peridural) membrane, The ligament of Hoffmann. The structures listed above along with dura, nerve roots, and Batson’s venous plexus all together stop the migration of the disc to the epidural space [<a href="#7" title="7">7</a>].</p> <p>Patients with posterior migration of a herniated disc may complain of low back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> or radiculopathy but commonly will present with cauda equina syndrome [<a href="#8" title="8">8</a>].</p> <p>MRI is the diagnostic modality of choice [<a href="#9" title="9">9</a>]. The migrated disc usually appears similar, although not identical to the cerebral spinal fluid signal intensity, and exhibits rim enhancement on the post-contrast sequences [<a href="#10" title="10">10</a>]. Computed tomography usually demonstrates a soft tissue nodule indenting and displacing the dural sac anteriorly The diagnosis of this rare form of the herniated disc is confounded by atypical imaging and symptoms mimicking an abscess, hematoma, facet cyst, or neoplastic process, leading to diagnostic difficulty and uncertainty in management.</p> <p>In our case patient presented with severe back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> and difficulty in Walking along with an increased frequency of urination which were sudden in onset and when the MRI lumbosacral spine demonstrated an epidural mass which is above the level of emptied disc space the possibility of an epidural mass or hematoma can not be ruled out. The treatment modalities of these entities are different from the surgical treatment of the migrated disc.</p> <p>Importantly, however, early diagnosis and treatment of PEMLDF have been shown to correlate with a positive clinical outcome. In a study from 2011, early <a target='_blank' href='https://www.iomcworld.org/medical-journals/surgery-2642.html'>surgery</a> within three days of symptom onset was one of two main factors contributing to a good or excellent prognosis using the modified Odom criteria 6. Identifying the correct <a target='_blank' href='https://www.iomcworld.org/medical-journals/pathology-12039.html'>pathology</a> is, therefore, paramount in providing optimal treatment.</p> <h4>Conclusion</h4> <p>Disc herniation is although a common disease entity but PEMLDF is a very rare event and till now very less reported worldwide.MRI lumbosacral spine is an imaging modality of choice in a patient with low back <a target='_blank' href='https://www.iomcworld.org/medical-journals/pain-2449.html'>pain</a> with features of CES(cauda equine syndrome) but sometimes it will increase the diagnostic dilemma. Early <a target='_blank' href='https://www.iomcworld.org/medical-journals/surgery-2642.html'>surgery</a> in PEMLDF is very rewarding.</p> <h4>Conflict of Interests</h4> <p>None.</p> <h4>References</h4> <ol> <li id='Reference_Title_Link' value='1'><a name="1" id='1'></a>Lichtor ,T. “<a href="https://www.sciencedirect.com/science/article/abs/pii/009030198990236X">Posterior epidural migration of extruded lumbar disk</a>”. <em>Surg Neurol</em>. 32.4(1989):311   <p>[<a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Lichtor+T.+Posterior+epidural+migration+of+extruded+lumbar+disk.+Surg+Neurol.+1989%3B32%3A311%E2%80%932&btnG=#d=gs_cit&t=1663571042506&u=%2Fscholar%3Fq%3Dinfo%3AiMPsFE8PpH0J%3Ascholar.google.com%2F%26output%3Dcite%26scirp%3D0%26hl%3Den">Google Scholar</a>]          [<a href="https://doi.org/10.1016/0090-3019(89)90236-X">Crossref</a>] </p> </li> <li id='Reference_Title_Link' value='2'><a name="2" id='2'></a>Takano , M., et al. “<a href="https://link.springer.com/article/10.1186/s12891-017-1516-2">Discography <a target='_blank' href='https://www.iomcworld.org/medical-journals/aids-113.html'>aids</a> definitive diagnosis of posterior epidural migration of lumbar disc          fragments: case report and literature review</a>”. <em>BMC Musculoskelet. 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J Korean Neurosurg Soc. 47.4(2010):217. <p>[<a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Kim+JS%2C+Lee+SH%2C+Arbatti+NJ.+Dorsal+extradural+lumbar+disc+herniation+causing+cauda+equina+syndrome%3A+a+case+report+and+review+of+the+literature.+J++Korean+Neurosurg+Soc.+2010%3B47%3A217%E2%80%9320&btnG=">Google Scholar</a>]          [<a href="10.3340/jkns.2010.47.3.217">Crossref</a>] </p> </li> </ol>   <div class="card bg-light mb-3"> <div class="card-body px-3 pb-0"> <h4 class="font-size-4"><a id="ai"></a>Author Info</h4> <a href='https://www.iomcworld.org/author/shrish-nalin-48681' title='Shrish Nalin' style='color:#555; border-bottom:1px dotted #CCC;'>Shrish Nalin</a><sup><a href='#a1'>1</a></sup><sup><a href='#Shrish_Nalin'>*</a></sup>, <a href='https://www.iomcworld.org/author/kanika-gupta-48682' title='Kanika Gupta' style='color:#555; border-bottom:1px dotted #CCC;'>Kanika Gupta</a><sup><a href='#a2'>2</a></sup>, <a href='https://www.iomcworld.org/author/amit-joshi-48683' title='Amit joshi' style='color:#555; border-bottom:1px dotted #CCC;'>Amit joshi</a><sup><a href='#a3'>3</a></sup> and <a href='https://www.iomcworld.org/author/mukesh-kumar-48914' title='Mukesh kumar' style='color:#555; border-bottom:1px dotted #CCC;'>Mukesh kumar</a><sup><a href='#a3'>3</a></sup> <div> </div> <a id="a1"></a><sup>1</sup>Department of neurosurgery Dr.RPGMC Tanda, Kangra (H.P.), India<br> <a id="a2"></a><sup>2</sup>consultant anesthetist, rotary child, and women hospital thakurdwara Palampur(H.P.), India<br> <a id="a3"></a><sup>3</sup>Department of neurosurgery Dr.RPGMC Tanda, Kangra (H.P.), India<br> <div> </div> <p><strong>Citation:</strong> Nalin S et al. Posterior Epidural Lumber Disc Migration Presenting as an Epidural Mass: A Rare Case Report with Diagnostic Dilemma. J Neurol Neurophysiol, 2022, 13(8), 001-002</p> <p> <strong>Received: </strong>27-Jul-2022, Manuscript No. JNN-22-70566; <strong>Editor assigned: </strong>29-Jul-2022, Pre QC No. JNN-22-70566 (PQ); <strong>Reviewed: </strong>30-Jul-2022, QC No. JNN-22-70566 (Q); <strong>Revised: </strong>23-Aug-2022, Manuscript No. JNN-22-70566 (R); <strong>Published:</strong> 31-Aug-2022, DOI: 10.35248/2471-268X.22.13.8.594 </p> <p><strong>Copyright: </strong>漏2022 Nalin S. 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