MyPACS.net: Radiology Teaching Files > Case 9391339

Never visited L4-5 DISC HERNIATION, EXTRUSION
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 23 year old female
History:

Rule out disc herniation, L5-S1. Radiating pain into buttocks and left calf. No hx of trauma.

Images:[small]larger

Fig. 1: AXIAL T1

Fig. 2: AXIAL T2

Fig. 3: SAGGITAL T1

Fig. 4: SAGGITAL T2 FATSAT

Fig. 5: SAGGITAL T2 FSE
Findings:

L5-S1: There is signal loss of the nucleus pulposus with mild loss of disc height. Dorsal annular bulging measuring 2 mm is seen. There is a posterocentral disc protrusion measuring 3 mm showing high intensity zone signal changes adjacent to the inferior discovertebral junction. This creates a small 3 mm protrusion. There is no compression or displacement of the S1 nerve roots. The posterior elements do not show spondylolysis and the facet joints are well maintained.


L4-5: There is signal loss of the nucleus pulposus with moderate loss of disc height. A focal large left paramedian disc herniation compatible with an extrusion measuring approximately 1 cm in diameter is clearly seen on sagittal images #5 and axial T2 images #13 and #14, and axial T1 images #9 and #10. This creates marked neural mass effect upon the left traversing L5 nerve root with dorsal displacement. Clinical correlation advised for left L5 radiculopathy. The posterior elements are well maintained.


The remaining intervertebral discs of the lumbar spine are unremarkable. The vertebral bodies do not show any compression fractures or aggressive osseous or marrow lesions. There is no intrinsic abnormality of the conus medullaris. The posterior lumbar musculature is symmetric without any significant atrophy or intrinsic abnormality. The retroperitoneal structures visualized on this examination are unremarkable.

Diagnosis:

1. LARGE FOCAL LEFT PARAMEDIAN DISC HERNIATION, L4-5, COMPATIBLE WITH AN EXTRUSION MEASURING APPROXIMATELY 1 CM IN DIAMETER. THIS HERNIATION CREATES MARKED NEURAL MASS EFFECT AND DORSAL DISPLACEMENT OF THE TRAVERSING LEFT L5 NERVE ROOT.

2. POSTEROCENTRAL DISC PROTRUSION AT L5-S1 AS OUTLINED ABOVE; NO NEURAL COMPRESSION. DESICCATION OF THE NUCLEUS PULPOSI, L4-5 AND L5-S1, WITH ASSOCIATED LOSS OF DISC HEIGHT.

References:

REFERRING PHYSICIAN: MICHAEL SANDERS, DC

Comments:
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Additional Details:

Case Number: 9391339Last Updated: 2011-07-11
Anatomy: Spine and Peripheral Nervous System   Pathology: Non-Infectious Inflammatory Disease
Modality: MRAccess Level: Readable by all users
Keywords: arthritis, degenerative joint disease, extrusion

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