Back pain and left L4 radiculopathy for investigation
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At L3-4 there is a small central disc extrusion. Adjacent and inferior to the disc filling the left lateral recess, is a well defined oval 12 x 7 x 12 mm lesion which is mildly T1 hyperintense, markedly T2 hyperintense with rim enhancement. Focal central small T2 hypointensity within the lesion either gas or proteinaceous fluid. The lesion appears to communicate with the extruded disc. The subjacent L4 nerve root is displaced and compressed in the subarticular recess.
At L5-S1 a small/moderate sized central/right paracentral disc protrusion contacting and displacing the right S1 nerve root. Tiny cyst posterior to the disc within the lateral recess.
This case demonstrates an L3-4 disc protrusion and associated discal cyst compressing the left L4 nerve root in the subarticular recess. There is also L5-S1 disc protrusion with early discal cyst formation.
Discal cysts occur when there is a communication between an intervertebral disc and an extradural cyst, thought to be due to a traumatic injury to the annulus fibrosis. It is a rare diagnosis with relatively few cases described in the literature, but appears to be most common in young males (90% male, average age 33.5 years).1 Discal cysts may regress spontaneously or can be resected surgically.1
- Diehn FE, Maus TP, Morris JM, Carr CM, Kotsenas AL, Luetmer PH, Lehman VT, Thielen KR, Nassr A, Wald JT. Uncommon Manifestations of Intervertebral Disk Pathologic Conditions. Radiographics : a review publication of the Radiological Society of North America, Inc. 36 (3): 801-23. doi:10.1148/rg.2016150223 - Pubmed