Presentation
Left leg pain down to dorsum of foot and big toe.
Patient Data
The vertebral height, alignment and bone marrow signal are unremarkable, other than an incidental L3 vertebral body hemangioma. The conus terminates at L1/2 and is normal in appearance.
T12/L1 to L3/4: Normal (Upper levels only imaged in sagittal plane)
L4/5: A sizable left posterolateral focal disc protrusion fills the subarticular recess and severely compresses the descending left L5 nerve root. It results in only minor neural exit foraminal narrowing. The canal is not significant narrowed on the right subarticular recess and foramen are unremarkable.
L5/S1: Broad-based disc protrusion combined with ligamentum flavum hypertrophy and facet joint degenerative change results in mild to moderate narrowing of the neural exit foramina, more so on the left where the exiting L5 nerve root is contacted but not clearly compressed. The canal remains capacious, and the S1 nerve roots are not compressed.
Conclusion:
Severe compression of the descending left L5 nerve root in the subarticular recess of L4/5, with further contact of the same nerve root in the neural exit foramen of L5/S1.
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