MyPACS.net: Radiology Teaching Files > Case 13023084

never visited PROTRUSION OF THE L4-L5 DISC
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 15 year old female
History: 15-year-old female with low back pain and right leg pain.
Images:[small]larger

Fig. 1: AP T-SPINE

Fig. 2: AP L-SPINE

Fig. 3

Fig. 4: AP SPOT L-SPINE

Fig. 5: LATERAL L-SPINE SPOT

Fig. 6: T2 SAGITTAL

Fig. 7: T2 SAGITTAL FATSAT

Fig. 8: T2 AXIAL
Findings:

MRI examination of the lumbar spine reveals the following:

L4-L5: There is a broad-based right paramedian 3 mm protrusion showing high intensity signal changes compatible with active concentric annular tear. This is clearly seen on axial T1 image 15 and sagittal images 7. This protrusion compresses upon the traversing right L5 nerve root. Clinical correlation advised for right L5 radicular involvement. Posterior elements are unremarkable.

Diagnosis:

1. BROAD-BASED RIGHT PARAMEDIAN 3 MM PROTRUSION AND ACTIVE CONCENTRIC ANNULAR TEAR OF THE L4-L5 DISC RESULTING IN COMPRESSION OF THE RIGHT L5 NERVE ROOT (AXIAL T2 IMAGE 15, SAGITTAL IMAGES 7).

Discussion: Protrusions are considered an early form of disc herniation. Disc herniations do occur in young patients as is seen in this case. Generally, it is perceived that disc herniations only happen in an aging spine but depending on the patient's lifestyle, biomechanics and genetic predisposition, protrusions can occur before complete skeletal maturity as is seen in this case.
References:

REFERRING PHYSICIAN: RONALD GRABOWSKI, DC

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Additional Details:

Case Number: 13023084Last Updated: 01-31-2008
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRExam Date: 01-29-2008Access Level: Readable by all users

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