Daniele Vanni, Renato Galzio, Anna Kazakova, Vincenzo Salini and Vincenzo Magliani
Introduction: The purpose of this work is to report a rare variation of lumbar disc herniation (LDH) not previously reported in the literature.
Case presentation: We describe this single case of young Caucasian male (23 years) afflicted with a double migrated LDH and we examine the problems associated both with the diagnostic aspects both with the therapeutic approach. According to our knowledge, no cases of simultaneous cranial and caudal migration of two adjacent LDH, with the consequent compression of the same spinal root is reported in literature. Specifically, the caudal migration concerned the fragment of the herniation of the level above, while the cranial migration affected the herniation of the level below. Thus these two fragments were placed towards one another, compressing the same spinal root. This atypical pattern of discs-root conflict was defined “kissing herniations”.
Conclusions: Although LDH generally does not provide for the migration of a fragment to the levels above or below, in 10% of the cases this might happen, but it is a single one, ordinarily. Infact a case of a double and convergent migration of two different fragments have never been reported before in the literature. The analysis of this case can help to better understand how a degenerative disc disease can evolve. Especially the analysis of this case allows understanding how the stresses of the discs can focus in some defined areas of the vertebral bodies and thus they can determine the suffering of the discs themselves. This type of case has an impact on various disciplines, including: orthopedics, neurosurgery, spine surgery, rheumatology, physiatry, neurology, general medicine.
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