MyPACS.net: Radiology Teaching Files > Case 12691755

never visited DISC HERNIATION L5-S1
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 42 year old male
History:

Rule out lumbar disc herniation.

Images:[small]larger

Fig. 1: AP T-SPINE

Fig. 2: AP L-SPINE

Fig. 3: AP L-SPINE SPOT

Fig. 4: LATERAL L-SPINE

Fig. 5: LATERAL L-SPINE SPOT

Fig. 6: SAGITTAL T1

Fig. 7: SAGITTAL T2

Fig. 8: SAGITTAL T2 FATSAT

Fig. 9: AXIAL T1 IMAGES 8/9/10

Fig. 10: AXIAL T1 IMAGES 11/12/13

Fig. 11: AXIAL T2 IMAGES 17/18/19

Fig. 12: AXIAL T2 IMAGES 20/21
Findings:

MRI:
MRI of the lumbar spine reveals the following:

L5-S1: There is signal loss nucleus pulposus with mild loss of disc height. A large posterocentral to right paramedian disc herniation compatible with an extrusion is present. This extrusion of nuclear material extends caudad to the S1 vertebral segment. The herniation measures approximately 1 cm in diameter x 2 cm in length. It creates marked stenosis and compression of the traversing right-sided nerve roots, predominantly S1, as well as creates mild compression of the exiting L5 nerve root. Additionally, there is prominent facet arthropathy, more pronounced on the left. The facet joints are asymmetric (tropism). The left facet joint is in a more atypical coronal plane. Spinal canal caliber is reduced by 50%. The herniation is best identified on sagittal images 6 and 7 and axial T1 images 8 through 13 and axial T2 images 17 through 21. clinical correlation advised for respective right-sided radicular involvement.


L4-L5: The disc is well maintained. There is mild facet arthropathy. There is no stenosis or neural compression.


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 a residual disc between S1 and S2 which was discussed in the radiographs performed same date. Spinal canal caliber is adequate with the exception of the stenotic effect created by the large herniation of L5-S1. The conus medullaris does not show any intrinsic abnormality. Paraspinal lumbar musculature is symmetric but does show mild diffuse atrophy. Retroperitoneal structures visualized in this exam are unremarkable.

XRAY:

There are five lumbar vertebral segments and 12 rib-bearing thoracic vertebral segments. Partial transition of the first sacral segment is identified with residual disc between S1 and S2. The L5-S1 level does show mild endplate spondylosis with narrowing of the disc and facet imbrication/hypertrophy. Remaining disc spacing is adequate. Lumbar lordosis is unremarkable. There is no structural scoliosis. There is mild right lateral deviation of the vertebral column. The soft tissues do not show any abnormal masses or calcifications. Incidentally observed are metallic staples superimposed over the pubic symphysis on the AP spot view compatible with a prior vasectomy.

Diagnosis:

MRI:
1. LARGE RIGHT POSTEROCENTRAL TO RIGHT PARAMEDIAN DISC HERNIATION OF L5-S1 COMPATIBLE WITH A 1 CM X 2 CM DISC EXTRUSION. THIS CREATES SIGNIFICANT STENOSIS AND COMPRESSION OF THE TRAVERSING NERVE ROOTS AS DISCUSSED.

2. FACET ARTHROPATHY AND ASYMMETRY (TROPISM) OF THE L5-S1 FACET JOINTS.

3. MILD FACET HYPERTROPHY L4-L5.

4. MILD DIFFUSE ATROPHY POSTERIOR LUMBAR MUSCULATURE.

XRAY:

1. FIVE LUMBAR VERTEBRAE AND 12 THORACIC VERTEBRAL SEGMENTS WITH RESIDUAL DISC BETWEEN S1 AND S2.

2. NO FRACTURE OR AGGRESSIVE BONE OR JOINT ABNORMALITY.

3. MILD DISC SPACE NARROWING AND FACET HYPERTROPHY L5-S1.

References:

REFERRING PHYSICIAN: JOHN FELKER, DC

Comments:
No comments posted.
Additional Details:

Case Number: 12691755Last Updated: 01-11-2008
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRExam Date: 01-09-2008Access Level: Readable by all users

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