Tuberculous Epidural Granuloma Simulating a Herniated Lumbar Disk

A tuberculous epidural granuloma was encountered in a 43-year-old man with a typical syndrome of lumbar disk herniation. Roentgenograms of the spine revealed only an anterior bony bridge between the vertebral bodies of L4 and L5, and a narrowing of the fourth intervetebral space. Myelogram showed a complete block of the dural sac, which appeared to be caused by an extradural mass located at the level of the L4-L5 disk. At operation granulomatous tissue was found in the anterior epidural space and the fourth intervertebral disk. On the basis of the radiographic and surgical findings, it is reasonable to assume that the infection spread to the epidural space from an inapparent vertebral focus either directly or by way of the intervertebral disk.