Posterolateral Disc Herniation with Superior Fragment Migration

Pathology

A posterolateral herniation with a superiorly migrated fragment means the nucleus pulposus has ruptured through the annulus fibrosus toward the back and side, and a piece has moved upward beyond the disc space. This often occurs in the lumbar or cervical spine.

Clinical Impact

The migrated fragment can compress nerve roots at a different level than the primary herniation, causing radicular pain, numbness, weakness, or sensory loss in a distinct distribution. Diagnosis requires MRI or CT myelography.

Treatment

• Conservative: NSAIDs, physical therapy, epidural steroids, activity modification.
• Surgical: Microdiscectomy or endoscopic removal if conservative measures fail or neurologic deficit progresses.