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Sequestered disc fragment - anybody?

AnonymousUserAAnonymousUser Posts: 49,671

I've been 3 months now with pain, burning, tingling and total numbness in my left thigh. Very annoying! The first MRI did not show anything really bad (so the NC said). Then I did an EMG, results were normal. Then I had a 2nd MRI a few days ago, I haven't seen the doctor yet, but I got the results. This one shows severe left foraminal stenosis at L2, caused by a "sequestered disc fragment". I guess its a fragment of the disc that moved from the disc body. Has anybody had that? Does it require surgery? At least now I know where my symptoms come from. I'll see the doctor this monday. In the meantime I am wondering if someone had a similar thing and can share his/her story.
Thank you so much!


  • I have had the same issue with my L5-S1 disc. I had a Discectomy then 3 weeks later another fragment broke off and pinned the sciatic nerve causing foot drop and required a 2nd operation to remove the new offending piece of disc. The foot drop has resolved but I still have nerve pain due to scarring and a build up of scar tissue on my Sciatic nerve. The two bits of disc ranged in size from 3cm x 2cm in the first op and the next bit that also had cartiledge attached to the fragment was 1.5cm x 1cm.
    Since then, I've had a fusion of L5-S1 and am looking at more surgery to remove bone from around that nerve root to see if that will settle my sciatic nerve.
    Best of luck with your back

  • Thank you for sharing. It must have been hell for you to go from one surgery to another in such a short time. Were both fragments from the same disc? Mine is at L2 and only about 1.2cm x 1cm. Anyway, my NS said that it will be a realtively simple surgery, the only thing is that the position of this fragment is a bit unusual and he'll have to make a longer cut and move more muscles. I am kina scared after reading your story! I hope that I will not need a fusion after, it seems that sometimes these surgeries mess up even more. Best of luck to you!
  • First and foremost I am not an MD.My understanding of a Sequestered disc - as defined through unknown source and jotted as notes:A sequestered disk is the end stage of an extruded disk,when the herniated disk material completely separates from the disk and becomes a free fragment,which floats around,just like a piece of loose cartilage in the knee.A Sequestered disc will need surgical intervention.while in the case of an extruded disc,conservative care should be tried first,with surgery as the last option.All the foregoing is quoted notes from unknown resource and correct information if it's wrong.Notes that I have acquired as information regarding my injury.Further more it is said that its important to know other general terms of disk herniation CONTAINED AND UN CONTAINED.It has been written that the distinction is important because contained disc herniation's generally will respond well with conservative care (chiropractic adjustments and exercise rehabilitation )while un-contained herniation will not.Contained disk herniation's include the terms disc bulge,disc herniation,disc protrusion,and focal disc herniation.Un-contained disc include the terms extruded disc and sequestered disc.Again it is written that sequestered disc will need surgical intervention.Please correct information if wrong or incomplete. Claude equine syndrome should be defined,and really regarded know the warning sign's if symptoms persist,said to be rare occurrence or syndrome.I compare that with Myelitis and question both diagnosis especially since both classifications can lead to paralysis,as well as permanent affliction accompanied with nerve pain or various types of Neurological deficits. The following are a few terms we all need to take the time to define and distinguish in our quest of discernment of our tribulations:subligamentous disc,disc protrusion,focal disc protrusion,extruded disc,or transligamentous disc,and finally the end stage of extruded disk a sequestered disc.All relating or resultant of slipped disc.Quotations not applied all quote unquote.
  • I recently had an MRI of my lumbar spine which reads at L 2–3 there is mild disc desiccation and circumferentialdisc bulge. In addition, there is a focal Ovide intermediate signal seen posterior to the superior aspect of L3 vertebral body in the left paracentral locationmeasuring 0.4×0.6×0.7 cm and is suggested for a sequestered exdruded disc fragment most likely from L2 – 3 level. Thisslightly indents the thecal sac without significant central canal stenosis this does touch and slightly displaced the left L3 exiting nerve root there is mild facet arthropathy and ligamentum flavum hyper trophy with mild bilateral neural for aminal narrowing. I'm not sure what all of this means. I have been going to physical therapy and has not had much relief, and I'm not too sure if I want to have an epidural. I took a Medrol dose pack and it did not help. My next step is to schedule an appointment with the neurosurgeon.I want to avoid surgery if possible. I have something going on from S -1through L5 but this one is worse.Any suggestions?
  • Lots of good answers to your questions cdvasquez. I can add only incrementally. Apparently the herniated disk is very common and much is known in the last 5 years with micro-surgery progress. I have recently had a "loose fragment" extrude from L3-4 disk. The MRI result said the following:

    "There is a superimposed left subarticular superiorly directed disc extrusion or free fragment extending from the left side of the L3-4 disc extending behind the left lower L3 vertebral body. This disc extrusion or free fragment measures roughly 7 mm AP x 8 mm TR x 18 mm CC."

    This body is larger then yours and is putting partial pressure on the nerve, Despite very minor inner thigh numbness and again minor weakness in thigh muscles, (and sometimes bad hip pain depending on my physical position), the extruded indication of free-floating does not make me an instant candidate for surgery. After long Brain-picking from the Kaiser spine group treating me I have learned a few things. !st is to have surgery as a very very last resort. Doc said a fair % of removal efforts result in a repeat of extrusions/scar tissue etc. Next, If numbness is contained and non-steroidal approaches (steroid epidurals) are taken ie: taking opioid drugs for pain, then the body immune system function called "resorption" kicks in and will break down and absorb the extrusion over time. Again, steroids will stop this process as it reduces immune system activity. That said, a short duration week or two of Prednisone can relieve initial excruciating pain I suffered at the outset. There is a newer drug called Gabapentin, that works on nerve pain specifically and was created for convulsions but works great to reduce nerve pain. As I transition off the 1 week of Prednisone, I will move to Gabapentin IF my codine based tylanol does not take up the pain slack from the Prednisone since I am not happy about the advertised side effects of this nerve drug. My goal is to get my body to resorb this body and the Dr says that is the way to go... I just don't have any idea how long that will take. Months to a year probably. Maybe someone out there can chime in on this. I have a steroid shot booked anyway just in case I just can not manage the pain in the next month. You do what you need to do to be pain free.
    That is my tale of woe. Just cancelled a Month trip to Australia/New Zealand, 2 years in the planning.. but enough about me. Best of luck to you and now a year later wonder how you are doing. Best wishes
  • Liz53Liz53 MissouriPosts: 142
    edited 01/30/2016 - 8:26 AM
    I had an extruded fragment at L3-4 about 3 yrs ago and it took almost 5 months of excruciating pain until it was discovered. It was missed on my reading of the MRI. I then had the surgery as it was horrible pain compressing my L4 nerve root. Fast forward to now 2 1/2 yrs post microdiscetomy and I have reherniated the same disc. Probably trying yoga which my physical therapist recommended. I have tried the conservative route , 2 epidurals and time almost 9 weeks and it is not getting better. The surgeon recommends having another microdiscetomy. I am very tired of it all! My extruded fragment did not go away on its own. It can happen. Good luck to you!
  • bisseksbbisseks Posts: 3
    edited 03/06/2016 - 8:20 PM
    Additional notes: After 2 months of my L3-4 disk extrusion I am drug and pain free, and back to running exercise. I consider myself very lucky that the free fragment is no longer pressing on the nerve and my left thigh numbness, and leg weakness has disappeared over the past 3 weeks. While I am hopeful that the body's resorb process will eventually absorb the extrusion over time, I am not naive to the fact that the fragment remains and could move around to press again on the nerve, so I keep pushing out the epidural shot week to week. At least I am evidence that this type of issue can possibly go away by itself. Good luck to all. 
  • Liz53Liz53 MissouriPosts: 142
    glad to hear of your success with your fragment being reapsorbed. I am going to put off my second microdiscetomy and wait a few more months if I can to see if I can make it without the surgery. I am continuing to have tightness in my thigh and discomfort with standing and sitting. Fortunately I can sleep and seem to have less severe pain and more bothersome discomfort that I hope will go away. It is good to hear a positive story!

  • I had disc sequestration first time 4 years ago. Didn't show up on the MRI. Was showing as a small contained bulge but lots of fragments found during surgery. Wondered why there was agonising pain. 6 months ago, reherniated disc. This time MRI showed uncontained extrusion, but again disc fragments had come free. I'm not sure whether the MRI are not very accurate or things deteriorated since the scan (been told both) but I was also told the fragments can be reabsorbed. Didn't happen for me. Not sure how much they know about why they sometimes get reabsorbed and pain managed and in other cases, it doesn't happen that way. I was told that if it's sequestered you have to be extra vigilant to any symptoms of numbness in saddle area.

    When I had my surgeries, the surgeon removed the large disc fragments which could be seen and easily removed to avoid another surgery soon after the original surgery (as happened to someone above), but it's tricky because they probably won't want to leave large disc fragments hanging round but removing too much can create it's only problems. I'm not telling you this to worry you so don't take fixate on this as you probably won't know the extent of the fragmentation anyway. Just simply saying this may have been why a second surgery was needed so soon after the first. If it's just one fragment, it's not as likely it will fragment again as if there are fragments left behind which haven't been removed. Hope that makes sense.
  • i had a 9mm disc protrusion but with not so much pain. The surgery on Dec, 2015 makes the pain worse. 
    It turns out that there are disc fragment inside my foramal. I do not want a surgery again. The surgery make people easy to have a reherniation.  I will wait it get aborbed by itself. 
    I read a bunch of research papers that mentioning the disc fragment can be aborbed by itself. 
    The large the the fragment, the higher possible it will got absorbed.  It is just very slow process. Annular tear takes two years to be absorbed.  Most of people do not need surgery. 
  • Liz53Liz53 MissouriPosts: 142
    Just to report back. I have avoided surgery and my disc has reabsorbed. I reherniated in November and was supposed to have surgery in March. Instead I started PT and things are slowly improving. Long haul but I am back to walking 5 miles a day. Not running yet and for the most part in less pain. Still I have discomfort in my leg and some back pain but better. It can happen that things get better without surgery!
  • ToddsBackTToddsBack MassachusettsPosts: 5
    I was just diagnosed with a sequestered disc fragment which measures 14 x 4 x 9 mm. The disc fragment contacts the left L3 nerve and causes severe left neural foraminal narrowing. The injury was in April - and I worked up until two weeks ago when it made it impossible to walk or stand for durations longer than 1 minute.

    I am in a lot of pain. I take 2400mg Ibuprofen / day  150 mg of Tramadol/ day and 900 mg of neurontin / day.  These meds allow me only to be able to sit and lay down with minimal pain.

    Is there anyway to avoid surgery?  

  • Liz53Liz53 MissouriPosts: 142
    Avoiding surgery is something to discuss with your surgeon. I got cold feet with the second herniation and it has been a long slow recovery for me. I experienced the extreme pain and inability to move or sit without a lot of discomfort. Slowly I mean since last November it has improved but I still have back and leg discomfort but I can attempt to function. Best to ask your surgeon or get another opinion and if you can avoid surgery it is one way to limit complications. Keep us posted what you find out.
  • Hi Liz53,
    Did you manage to try yoga after all? I mean before starting-off to walk, did you try yoga to get any relief? I practiced yoga but I don't know how, I was just diagnosed to have an extruding disc/sequestered fragment at L5-S1. I am thinking of taking up yoga again for recovery. 
  • Liz53Liz53 MissouriPosts: 142
    In my case the yoga caused my disc to reherniate. I found yoga to not be helpful for me. I should have practiced it long before when I was a runner. Most likely I injured my disc because I was not strong or flexible . Hindsight but yoga might have been good for me before my injury. Not now.
  • SavageSavage United StatesPosts: 5,427
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