Extraforaminal disc extrusion

Case contributed by Dr Henry Knipe

Presentation

Low back pain radiating into the right buttock and thigh.

Patient Data

Age: 70 years
Gender: Male

L4-5 disc osteophyte complex with a superimposed right extraforaminal disc herniation. Effacement of fat in the right neural exit foramen. 

Degenerative disc and facet joint change at the lumbar other levels. 

MRI

L4-5 disc osteophyte complex with a superimposed right extraforaminal disc herniation with displacement of the right L4 nerve root. Moderate right neural exit foraminal stenosis without flattening of the right L4 nerve root. Additional epidural fat and severe bilateral facet joint arthropathy results in moderate central canal stenosis. Mild left neural exit foraminal stenosis.

Degenerative disc and facet joint change at the lumbar other levels. 

Case Discussion

The extraforaminal zone is a check area on spine imaging, as it is an easy place to miss a disc herniation. Whether this disc herniation is symptomatic or not is not known, as the clinical notes do not really match L4 distribution radiculopathy. 

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