MyPACS.net: Radiology Teaching Files > Case 11153388

previously visited FAR LATERAL L2-L3 LEFT DISC HERNIATION (EXTRUSION)
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 58 year old male
History:
58 year old male with back pain and leg pain.  History of prior L5-S1 hemilaminotomy in 1990.  Rule out disc herniation vs. post operative complication.
Images:[small]larger

Fig. 1: AP LUMBAR

Fig. 2: LATERAL LUMBAR SPINE

Fig. 3: T1 Sagittal left parasagittal images #2,3,4. Notice herniated material occluding neuroforamen.

Fig. 4: T2 Sagittal left parasagittal images #2,3,4. Notice herniated material occluding neuroforamen.

Fig. 5: T2 Sagittal FatSat left parasagittal images #2,3,4. Notice herniated material occluding neuroforamen.

Fig. 6: T2 Axial images #6 and #7 through L2-L3 disc. Note left far lateral disc extrusion.

Fig. 7: T2 AXIAL #20 through L5-S1 disc. Note changes in posterior elements from prior surgery. No recurrent HNP or other post-op complicaitons.

Fig. 8: T1 Sagittal midline image through same patient.

Fig. 9: T2 AXIAL - Normal axial image through L1-L2 disc same patient.
Findings: XRAY LUMBAR SPINE

There are five lumbar vertebrae. No gross scoliotic deformity is identified. The sagittal contour is unremarkable. The L5-S1 disc space is moderately narrowed. Intervertebral disc height is otherwise within expected limits. Mild anterolateral spondylosis is present throughout the lumbar spine. Sacroiliac articulations are unremarkable. Cortical margins and trabecular patterns are intact.


MRI LUMBAR SPINE

L5-S1: There is evidence of a prior left hemilaminotomy and partial discectomy. No recurrent disc herniation is revealed. The disc shows moderate loss of disc height and desiccation of the nucleus. There is no displacement of the traversing nerve roots. Posterior elements do not show any focal osseous or marrow lesions other than the prior surgical changes which are clearly seen on axial T2 image #20.


L2-L3: There is a large left far lateral disc herniation compatible with an extrusion that measures approximately 1.5 cm occluding the left neural foramen. Low-signal T1, high-signal T2 characteristics of the disc herniation is noted indicating recent onset. There are associated annular tears and visualization of the extruded nuclear material through the annular derangement. This disc herniation is clearly seen on sagittal images 2, 3, and 4 and axial T2 images 6 and 7. This extrusion of nuclear material results in marked compression of the exiting L2 nerve root and dorsal root ganglion. The medial most base of the herniation causes mild compression upon the traversing L3 nerve root. There is mild facet hypertrophy and the spinal canal caliber measures in the lower limits of normal.

Diagnosis:

LARGE LEFT FAR LATERAL DISC HERNIATION COMPATIBLE WITH A 1.5 CM EXTRUSION OF NUCLEAR MATERIAL OBLITERATING THE NEURAL FORAMEN AND COMPRESSING THE LEFT EXITING L2 NERVE ROOT.

References: Referring Physician:  George Junkin,DC
Comments:
No comments posted.
Additional Details:

Case Number: 11153388Last Updated: 10-10-2007
Anatomy: Spine and Peripheral Nervous System   Pathology: Other
Modality: Conventional Radiograph, MRExam Date: 10-02-2007Access Level: Readable by all users
Keywords: disc herniation, extrusion, far lateral disc,

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