L4-5 focal right paracentral disc extrusion impinging on the descending right L5 nerve root in the lateral recess
Presentation
Acute-on-chronic back pain. 2/52 R sciatic pain. Reduced power and sensation in right leg ?impingement.
Patient Data
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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