The "crumble disc sign": preoperative MRI predictor of intradural lumbar disc extrusion.
Ayça Seyfettin, Emre Utkan Büyükceran, Andelib Babatürk et al.
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Case in brief
A 64-year-old woman with a history of lumbar surgery presented with recurrent L4-5 disc extrusion. Preoperative MRI revealed a unique 'crumble disc sign,' characterized by irregular and fragmented disc material within the thecal sac. This finding led to the suspicion of intradural disc migration, which was confirmed during surgery, revealing two intradural disc fragments and a dural defect.
What made this case unusual
The 'crumble disc sign' is a distinctive MRI finding that indicates fragmented intradural disc material, which is atypical compared to the usual presentation of a well-defined mass.
Diagnostic / clinical pearl
Clinicians should be aware that the 'crumble disc sign' on MRI may indicate intradural disc migration, particularly in patients with a history of lumbar surgery and recurrent symptoms.
Why it matters
Recognizing this sign can help differentiate intradural disc herniation from solid intradural tumors, potentially guiding surgical planning and improving patient outcomes.