Cauda equina compression
No history provided, other than 'back pain'.
MRI lumbar spine
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MRI of the lumbar spine demonstrates a very large focal central disc extrusion almost entirely fills the canal at L4/5, compressing the cauda equina posteriorly and slightly to the left.
The L5/S1 level demonstrates desiccated disc with some degenerative change of the facet joints contributing to moderate right sided and severe left sided neural exit foraminal stenosis. The canal is capacious.
The remainder of the lumbar spine is unremarkable. Incidental note is made of hemangioma in the vertebral body of L3.
This case illustrates the typical appearances of a large disc extrusion compressing the cauda equina. This is in many instances a surgical emergency requiring decompression. This is especially the case if there is bowel or bladder function impairment or lower limb weakness.