Presentation
Three weeks of right sided sciatica, now presenting with three days painful right foot drop.
Patient Data
L2/3: disc dessication and shallow non-compressive central disc protrusion
L4/5: edematous endplate signal with right subarticular disc extrusion (minor disc component migration superiorly) and moderate posterior element degenerative change, resulting in compression of the transiting right L5 nerve root. Cauda equina contact but no frank neural compression. Mild right L4 exit foraminal stenosis but no neural compression.
L5/S1: loss of disc height and fatty endplate degenerative change. Noncompressive disc protrusion and mild posterior element degeneration. No central neural compression. Bilateral moderate L5 exit stenoses.
The remaining disc levels are unremarkable. Otherwise normal marrow signal. Normal distal cord and conus. No concerning extraspinal finding.
Imaged 6 mth later with worsening symptoms
Even allowing for changes in technique, equipment and positioning, the large disc protrusion at right L4/5 level appears no worse than on the prior scan (and suggests interval radiological improvement despite symptoms). No central neural compression.
Case Discussion
Impression: L4/5 right-sided subarticular disc extrusion with right L5 nerve root compression, likely symptomatic.
The patient underwent urgent neurosurgical review, and was managed conservatively with no structural sequelae on the later MRI.