{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T19:21:11Z","timestamp":1775848871861,"version":"3.50.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,4,21]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Atypical lumbar disc herniations, such as migratory extreme lateral and intradural herniations, can mimic malignancy on imaging, complicating diagnosis and treatment. These herniations can involve unusual locations, such as the retroperitoneal or presacral area. Migratory herniations, in particular, can appear similar to peripheral nerve sheath tumors, presenting diagnostic challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors present the case of a 39-year-old male with symptomatic migratory extreme lateral disc herniation causing L5 radiculopathy. Initial MRI suggested a peripheral nerve sheath tumor, and positron emission tomography\/CT (PET\/CT) showed minimal metabolic activity. Biopsy confirmed a migratory disc herniation, which was treated with anterior lumbar interbody fusion at L5\u2013S1 via a pararectus approach. The patient showed significant pain relief and improvement in hypoesthesia postsurgery, but L5 motor weakness remained unchanged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Imaging can be unreliable in distinguishing migratory disc herniation from tumors. Although MRI and PET\/CT are standard tools, they can show features that overlap with neoplastic processes. Histopathological evaluation remains crucial for accurate diagnosis. The pararectus approach provides excellent access for biopsy and direct decompression in cases of atypical herniations, minimizing recurrence risk while addressing concurrent disc degeneration. This case highlights the importance of comprehensive imaging and interdisciplinary discussions when diagnosing and treating rare disc herniations, with the pararectus approach offering a viable surgical solution for these challenging cases. Surgeons should consider atypical herniation locations when diagnosing lumbar radiculopathy, especially in cases where imaging is inconclusive. For retroperitoneal herniations, the pararectus approach allows for both diagnostic biopsy and effective surgical management, including decompression and fusion in a single procedure.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24866\">https:\/\/thejns.org\/doi\/10.3171\/CASE24866<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24866","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T20:10:23Z","timestamp":1745266223000},"source":"Crossref","is-referenced-by-count":1,"title":["Surgical management of symptomatic retroperitoneal migratory disc herniation anterior to the sacral ala causing L5 radiculopathy using direct decompression and fusion: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9366-6375","authenticated-orcid":true,"given":"Jan","family":"Gewiess","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"V\u00f6gelin","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"Kasparkova","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius J. B.","family":"Keel","sequence":"additional","affiliation":[{"name":"Spine-Pelvis AG, Medical School, University of Zurich, Trauma Center Hirslanden, Clinic Hirslanden, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer J.","family":"Egli","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1829-4820","authenticated-orcid":true,"given":"Moritz C.","family":"Deml","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph E.","family":"Albers","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Neurosurgery","first-page":"E419","article-title":"An unusual case of footdrop: anterior disc herniation mimicking a nerve sheath tumor","volume":"66","author":"Levene","year":"2010","unstructured":"Levene HBNimmagadda ALevi AD.An unusual case of footdrop: anterior disc herniation mimicking a nerve sheath tumor. Neurosurgery. 2010;66(2):E419-E420."},{"issue":"12","key":"bib2","series-title":"Spine J","first-page":"e7","article-title":"L5-S1 extraforaminal intraneural disc herniation mimicking a malignant peripheral nerve sheath tumor","volume":"12","author":"Sharma","year":"2012","unstructured":"Sharma MSMorris JMPichelmann MASpinner RJ.L5-S1 extraforaminal intraneural disc herniation mimicking a malignant peripheral nerve sheath tumor. Spine J. 2012;12(12):e7-e12."},{"issue":"4","key":"bib3","series-title":"Bone Joint J","first-page":"470","article-title":"Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation","volume":"101-B","author":"Fjeld","year":"2019","unstructured":"Fjeld ORGr\u00f8vle LHelgeland JComplications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation. Bone Joint J. 2019;101-B(4):470-477."},{"issue":"3","key":"bib4","series-title":"JOR Spine","article-title":"The influence of intervertebral disc overloading on nociceptor calcium flickering","volume":"6","author":"Gewiess","year":"2023","unstructured":"Gewiess JEglauf JSoubrier AThe influence of intervertebral disc overloading on nociceptor calcium flickering. JOR Spine. 2023;6(3):e1267."},{"issue":"9","key":"bib5","series-title":"Spine J","first-page":"1970","article-title":"Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation","volume":"14","author":"Daghighi","year":"2014","unstructured":"Daghighi MHPouriesa MMaleki MMigration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation. Spine J. 2014;14(9):1970-1977."},{"issue":"14","key":"bib6","series-title":"J Neurosurg Case Lessons","first-page":"CASE22552","article-title":"Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases","volume":"5","author":"Uy","year":"2023","unstructured":"Uy BRSun MZMuftuoglu YUpper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases. J Neurosurg Case Lessons. 2023;5(14):CASE22552."},{"issue":"3","key":"bib7","series-title":"Radiographics","first-page":"801","article-title":"Uncommon manifestations of intervertebral disk pathologic conditions","volume":"36","author":"Diehn","year":"2016","unstructured":"Diehn FEMaus TPMorris JMUncommon manifestations of intervertebral disk pathologic conditions. Radiographics. 2016;36(3):801-823."},{"issue":"1","key":"bib8","series-title":"J Craniovertebr Junction Spine","first-page":"101","article-title":"Extraforaminal lumbar herniated disc mimicking foraminal tumor: case report, literature review, and the role for minimally invasive approach for resection","volume":"13","author":"Avila","year":"2022","unstructured":"Avila MJChua RV.Extraforaminal lumbar herniated disc mimicking foraminal tumor: case report, literature review, and the role for minimally invasive approach for resection. J Craniovertebr Junction Spine. 2022;13(1):101-105."},{"issue":"3","key":"bib9","series-title":"Can Assoc Radiol J","first-page":"176","article-title":"Pictorial essay: imaging of peripheral nerve sheath tumours","volume":"62","author":"Chee","year":"2011","unstructured":"Chee DWYPeh WCGShek TWH.Pictorial essay: imaging of peripheral nerve sheath tumours. Can Assoc Radiol J. 2011;62(3):176-182."},{"issue":"5","key":"bib10","series-title":"Radiographics","first-page":"1477","article-title":"Schwannoma: radiologic-pathologic correlation","volume":"24","author":"Beaman","year":"2004","unstructured":"Beaman FDKransdorf MJMenke DM.Schwannoma: radiologic-pathologic correlation. Radiographics. 2004;24(5):1477-1481."},{"issue":"2","key":"bib11","series-title":"Pediatr Radiol","first-page":"124","article-title":"MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign","volume":"27","author":"Bhargava","year":"1997","unstructured":"Bhargava RParham DMLasater OEChari RSChen GFletcher BD.MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol. 1997;27(2):124-129."},{"issue":"12","key":"bib12","series-title":"Bratisl Lek Listy","first-page":"712","article-title":"Histological composition of lumbar disc herniations related to the type of herniation and to the age","volume":"113","author":"Matveeva","year":"2012","unstructured":"Matveeva NZivadinovik JZdravkovska MJovevska SBojadzieva B.Histological composition of lumbar disc herniations related to the type of herniation and to the age. Bratisl Lek Listy. 2012;113(12):712-717."},{"issue":"1","key":"bib13","series-title":"BMC Musculoskelet Disord","first-page":"567","article-title":"Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy","volume":"21","author":"Ford","year":"2020","unstructured":"Ford JJKaddour OGonzales MPage PHahne AJ.Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy. BMC Musculoskelet Disord. 2020;21(1):567."},{"issue":"3","key":"bib14","series-title":"Acta Neuropathol","first-page":"295","article-title":"Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems","volume":"123","author":"Rodriguez","year":"2012","unstructured":"Rodriguez FJFolpe ALGiannini CPerry A.Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems. Acta Neuropathol. 2012;123(3):295-319."},{"issue":"3","key":"bib15","series-title":"Arch Orthop Trauma Surg","first-page":"343","article-title":"Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note","volume":"140","author":"H\u00e4ckel","year":"2020","unstructured":"H\u00e4ckel SAlbers CEBastian JDHoppe SBenneker LMKeel MJB.Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note. Arch Orthop Trauma Surg. 2020;140(3):343-351."},{"issue":"2","key":"bib1","series-title":"Neurosurgery","first-page":"E419","article-title":"An unusual case of footdrop: anterior disc herniation mimicking a nerve sheath tumor","volume":"66","author":"Levene","year":"2010","unstructured":"Levene HBNimmagadda ALevi AD.An unusual case of footdrop: anterior disc herniation mimicking a nerve sheath tumor. Neurosurgery. 2010;66(2):E419-E420."},{"issue":"12","key":"bib2","series-title":"Spine J","first-page":"e7","article-title":"L5-S1 extraforaminal intraneural disc herniation mimicking a malignant peripheral nerve sheath tumor","volume":"12","author":"Sharma","year":"2012","unstructured":"Sharma MSMorris JMPichelmann MASpinner RJ.L5-S1 extraforaminal intraneural disc herniation mimicking a malignant peripheral nerve sheath tumor. Spine J. 2012;12(12):e7-e12."},{"issue":"4","key":"bib3","series-title":"Bone Joint J","first-page":"470","article-title":"Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation","volume":"101-B","author":"Fjeld","year":"2019","unstructured":"Fjeld ORGr\u00f8vle LHelgeland JComplications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation. Bone Joint J. 2019;101-B(4):470-477."},{"issue":"3","key":"bib4","series-title":"JOR Spine","article-title":"The influence of intervertebral disc overloading on nociceptor calcium flickering","volume":"6","author":"Gewiess","year":"2023","unstructured":"Gewiess JEglauf JSoubrier AThe influence of intervertebral disc overloading on nociceptor calcium flickering. JOR Spine. 2023;6(3):e1267."},{"issue":"9","key":"bib5","series-title":"Spine J","first-page":"1970","article-title":"Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation","volume":"14","author":"Daghighi","year":"2014","unstructured":"Daghighi MHPouriesa MMaleki MMigration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation. Spine J. 2014;14(9):1970-1977."},{"issue":"14","key":"bib6","series-title":"J Neurosurg Case Lessons","first-page":"CASE22552","article-title":"Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases","volume":"5","author":"Uy","year":"2023","unstructured":"Uy BRSun MZMuftuoglu YUpper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases. J Neurosurg Case Lessons. 2023;5(14):CASE22552."},{"issue":"3","key":"bib7","series-title":"Radiographics","first-page":"801","article-title":"Uncommon manifestations of intervertebral disk pathologic conditions","volume":"36","author":"Diehn","year":"2016","unstructured":"Diehn FEMaus TPMorris JMUncommon manifestations of intervertebral disk pathologic conditions. Radiographics. 2016;36(3):801-823."},{"issue":"1","key":"bib8","series-title":"J Craniovertebr Junction Spine","first-page":"101","article-title":"Extraforaminal lumbar herniated disc mimicking foraminal tumor: case report, literature review, and the role for minimally invasive approach for resection","volume":"13","author":"Avila","year":"2022","unstructured":"Avila MJChua RV.Extraforaminal lumbar herniated disc mimicking foraminal tumor: case report, literature review, and the role for minimally invasive approach for resection. J Craniovertebr Junction Spine. 2022;13(1):101-105."},{"issue":"3","key":"bib9","series-title":"Can Assoc Radiol J","first-page":"176","article-title":"Pictorial essay: imaging of peripheral nerve sheath tumours","volume":"62","author":"Chee","year":"2011","unstructured":"Chee DWYPeh WCGShek TWH.Pictorial essay: imaging of peripheral nerve sheath tumours. Can Assoc Radiol J. 2011;62(3):176-182."},{"issue":"5","key":"bib10","series-title":"Radiographics","first-page":"1477","article-title":"Schwannoma: radiologic-pathologic correlation","volume":"24","author":"Beaman","year":"2004","unstructured":"Beaman FDKransdorf MJMenke DM.Schwannoma: radiologic-pathologic correlation. Radiographics. 2004;24(5):1477-1481."},{"issue":"2","key":"bib11","series-title":"Pediatr Radiol","first-page":"124","article-title":"MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign","volume":"27","author":"Bhargava","year":"1997","unstructured":"Bhargava RParham DMLasater OEChari RSChen GFletcher BD.MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol. 1997;27(2):124-129."},{"issue":"12","key":"bib12","series-title":"Bratisl Lek Listy","first-page":"712","article-title":"Histological composition of lumbar disc herniations related to the type of herniation and to the age","volume":"113","author":"Matveeva","year":"2012","unstructured":"Matveeva NZivadinovik JZdravkovska MJovevska SBojadzieva B.Histological composition of lumbar disc herniations related to the type of herniation and to the age. Bratisl Lek Listy. 2012;113(12):712-717."},{"issue":"1","key":"bib13","series-title":"BMC Musculoskelet Disord","first-page":"567","article-title":"Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy","volume":"21","author":"Ford","year":"2020","unstructured":"Ford JJKaddour OGonzales MPage PHahne AJ.Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy. BMC Musculoskelet Disord. 2020;21(1):567."},{"issue":"3","key":"bib14","series-title":"Acta Neuropathol","first-page":"295","article-title":"Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems","volume":"123","author":"Rodriguez","year":"2012","unstructured":"Rodriguez FJFolpe ALGiannini CPerry A.Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems. Acta Neuropathol. 2012;123(3):295-319."},{"issue":"3","key":"bib15","series-title":"Arch Orthop Trauma Surg","first-page":"343","article-title":"Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note","volume":"140","author":"H\u00e4ckel","year":"2020","unstructured":"H\u00e4ckel SAlbers CEBastian JDHoppe SBenneker LMKeel MJB.Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note. 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