Presentation
Lower back pain, radiates to the right lower limb. Associated with paresthesia.
Patient Data
Diffuse posterior disc bulging seen with some extrusion/sequestration of nuclear material in the midline and extending inferiorly. This extruded/sequestered fragment measures up to 2.7 cm craniocaudal and up to 1.1 x 1.4 cm in the axial plane. Significant central canal stenosis with AP diameter measuring 0.3 cm with impingement of the right S1 traversing nerve root. Bilateral L5 exiting nerve roots are preserved.
Mild facet joint arthropathy or ligamentum flavum hypertrophy.
The migrated disc showed typical characteristic peripheral enhancement post contrast.
Case Discussion
Degenerative disc disease of the lower lumbosacral spine, L5/S1 extruded/sequestered lumbar disc with severe spinal canal stenosis and impingement of right S1 traversing nerve root.
Administering contrast is useful for increasing diagnostic confidence of sequestrated disc, as it will usually show peripheral rim enhancement. The appearance of peripheral rim enhancement of sequestrated disc is particular useful if the migrated disc is not in continuity with the parent disc, where other extradural lesions (metastasis, hematoma) can cause diagnostic dilemma.
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