L4/5 disc extrusion causing cauda equina syndrome
Obese male with acute on chronic lower back pain.
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L4/5 disc desiccation with large central disc extrusion causing severe spinal canal stenosis, effacing the CSF surrounding the intrathecal nerve roots of the cauda equina. There is no neural foraminal stenosis.
There is also L5/S1 disc desiccation with posterior annular fissure and mild broad-based disc bulge, not causing spinal canal or neural foraminal stenosis.
The patient was referred to neurosurgery with lower back pain, saddle anesthesia, urinary retention and severe lower limb weakness. After the clinical diagnosis of cauda equina syndrome was made, he underwent emergent surgical decompression with L4/5 laminectomy and discectomy.
The patient was subsequently discharged home with the resolution of his urinary symptoms and the return of sensation and lower limb power.