Extruded disc with nerve impingement

Case contributed by Ian Bickle
Diagnosis almost certain

Presentation

Increasing left sided back pain radiating into the left leg. Objective neurology on examination in the S1 distribution.

Patient Data

Age: 45 years
Gender: Male

Large extruded left paracentral disc at L5-S1 which is compressing the descending left S1 nerve root in the lateral recess.  The disc extends infrapedicularly.

No impingement of the exiting left right L5 nerve root.

The remaining levels are normal in appearance.

Case Discussion

This is the typical appearances of an extruded intervertebral disc, with the base of the disc narrower than the down.

One can exquisitely observe the disc impinging on the nerve root in the lateral recess.

This is an isolated finding in an otherwise normal looking lumbar spine.

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