Presentation
Acute onset of severe low back pain radiating to the legs, weakness in both lower limb, perianal paresthesia and sexual dysfunction
Patient Data
L5-S1 show reduction in intervertebral disc height with associated desiccation. A central disc extrusion resulting in severe spinal canal stenosis compressing on the cauda equina is also seen. The lateral recesses and neuroforamina are also narrowed resulting in compression of the exiting and traversing nerve roots. High T1 and T2 signal are seen at the inferior end plate of L5 and superior endplate of S1 consistent with Type 2 Modic changes.
The rest of the demonstrated lumbar intervertebral discs, spinal canal and neural foramina are unremarkable.
Features are those of degenerative disc disease causing disc extrusion at L5-S1 with compression of the cauda equina and bilateral L5-S1 nerve root compression.
Case Discussion
One of the degenerative etiology of cauda equina compression is lumbar disc herniation most common at L4/5 and L5/S1 which is the case in the patient with L5/S1 central disc extrusion.
Based on the clinical presentation of an acute severe low back pain, bilateral radiculopathy, perianal paresthesia coinciding with sexual dysfunction, an impression of cauda equina syndrome was made.
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