Foraminal zone disc extrusion

Case contributed by Dr Henry Knipe

Presentation

Few weeks history of low back pain associated with left hemiscrotum and thigh numbness.

Patient Data

Age: 45 years
Gender: Male
MRI

Transitional lumbosacral anatomy with lumbarization of S1 (proven with whole spine localizers, not shown). Scattered vertebral hemangiomas. Right S1 pars interarticularis defect and spinous process cleft. No bone marrow edema. 

L2-3: Left foraminal zone disc extrusion results in severe left neural exit foraminal stenosis with compression of the exiting left L2 nerve root. Central canal and neural exit foramina are capacious.

Case Discussion

Without paying close attention to the sagittal T1 sequence, this foraminal disc extrusion could be easily missed with the disc appearing similar T2 signal to nerve roots and the posterior disc appearing completely normal. A good habit is to review the neural exit foramina on the sagittal T1 for loss of normal fat signal so foraminal disc extrusions are not missed. 

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