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Disc extrusion (diagnostic discography)

Case contributed by G Balachandran
Diagnosis certain

Presentation

Referred for evaluation of chronic low backache.

Patient Data

Age: 35 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Sagittal T2W and T1W sequences show an isointense mass close to degenerated L4/L5 disc. The patient has complete L5 sacralization.

Axial T2W sequence shows the extradural mass was seen attached to the parent disc.

Discography Lx spine

x-ray

Lateral spot film after lumbar discography shows contrast extravasating around the extruded L4/L5 disc material ruling out any possibility of a tumor.

AP view spot film lumbar discography shows the contrast-laden disc between L4/L5. Note complete L5 sacralization.

Axial CT after discography showing contrast extravasation from disc space into the spinal canal encircling extruded disc material, simulating ring enhancement.

The last image shows residual contrast agent in disc space.

Case Discussion

The most common cause of extradural mass in lumbar region is disc material. The morphology of the lesion depends upon whether it is the disc protrusion, extrusion or sequestration. Moreover, a tumor has to be ruled out before surgery.

In our case, L4/L5 disc was degenerated with a mass attached to it indicating disc extrusion. We wanted to rule out any possibility of a tumor. So we performed a discography under fluoroscopy guidance which unequivocally confirmed the disc extrusion and ruled out any tumor. CT axial images were also obtained to cross-check discography findings. At surgery, a 17 x 16 mm disc extrusion was confirmed.

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