L4-5 focal right paracentral disc extrusion impinging on the descending right L5 nerve root in the lateral recess

Case contributed by Dr Henry Knipe

Presentation

Acute-on-chronic back pain. 2/52 R sciatic pain. Reduced power and sensation in right leg ?impingement.

Patient Data

Age: 33
Gender: Male

Vertebral body height and bone marrow signal is normal. Intravertebral disc space height and signal is normal. Conus terminates at L1 and has a normal appearance.

L4-5: Focal right paracentral disc extrusion extends inferiorly and impinges the descending right L5 nerve root in the right lateral recess. No significant central canal or foraminal narrowing.

L5-S1: Broad-based posterior disc bulge, eccentric on the left, results in mild left foraminal narrowing but no significant nerve impingement. No central canal narrowing.

All other levels are unremarkable with a capacious spinal canal and intervertebral foramina. No retroperitoneal abnormality noted.

Case Discussion

This case demonstrates that there can be multiple points of impingement for nerve roots in the lumbar spine, not just at the intervertebral foreman. 

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Case information

rID: 34392
Case created: 18th Feb 2015
Last edited: 6th Jan 2016
Inclusion in quiz mode: Included

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