Sequestrated disc

Case contribution: Dr Radhiana Hassan


  • A 42 years old man
  • No known medical illness
  • Presented with low back pain
  • Associated with mild physical exertion
MRI of lumbosacral spine in sagittal plane
MRI of the lumbosacral spine in T2WI
MRI of lumbosacral spine in axial plane

MRI findings:

  • Normal alignment of the lumbar vertebrae. The vertebral body heights are normal.
  • Posterior to the L3 vertebral body, there is an oval-shaped lesion (yellow arrows) which is hypointense on T1, hyperintense on T2 and not suppressed on fat suppression sequence. This lesion showed peripheral rim enhancement on post contrast image.
  • The signal intensity is similar with the L3/L4 disc in all sequences. The disc at this level is also reduced in height (white arrows).
  • This lesion measured about 13x11mm in size.
  • It is located more towards left side of the spinal canal.
  • Lesion posterior to L3 vertebra is suggestive of sequestered disc.

Diagnosis: Disc sequestration (proven intra-operatively)


  • Disc sequestration corresponds to extruded disc material that has no continuity with the parent disc and is displaced away from the site of extrusion.
  • It is also called free disc fragment or migrated disc.
  • The disc fragment can compress the spinal nerve root, causing pain and symptoms similar to herniated discs.
  • Migrated disc fragments usually appear hyperintense in 80% of cases on T2-weighted images, and hypointense on T1-weighted images, as compared with the disc origin.
  • Rim enhancement after gadolinium injection is usually shown around the extruded fragment and is related to the presence of inflammatory response and neovascularization as in this case.
  • Hematomas, abscesses and synovial cysts followed by neoplasms like schwannoma and mengioma are the specific lesions most frequently misdiagnosis with posterior sequestrated disc herniation.


Author: radhianahassan