L4/5 left paracentral disc extrusion with left L5 and S1 nerve root compression and left S1 nerve root enhancement

Case contributed by Dr Henry Knipe

Presentation

Two weeks of left leg L4/5 radiculopathic pain and foot drop. Past history of L4/5 microdisectomy for right leg sciatica.

Patient Data

Age: 40
Gender: Female

Mild to moderate scoliosis convex to the left. Vertebral height, alignment and intervertebral disc height as are within normal limits. Modic type II changes at L4 inferior and L5 superior endplates. Transitional lumbosacral anatomy is suspected, with the lowest disc level designated L5-S1. With this designation, the right hemilaminectomy has been performed at L4-5 and the conus  terminates at the T12 level and is normal in appearance. 

T12/L1 - L2/3: Unremarkable.

L3/4: mild focal central disc protrusion. No central canal or foraminal stenosis. 

L4/5: large left paracentral focal disc extrusion impinging the descending left L5 nerve root in its lateral recess and also contacting the descending left S1 nerve root, which proximal to the impingement is prominently enhancing. Minimal epidural scar tissue. No central canal or foraminal stenosis. 

Conclusion: Significantly larger left paracentral focal disc extrusion impinging the descending left L5 nerve root in the lateral recess with enhancement of this compressed nerve root.

Case Discussion

Nerve root enhancement is common in post-operative lumbar spines with recurrence of symptoms and is highly correlated with clinical symptoms. 

The patient proceeded onto elective L4/5 microdiscectomy.

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Case Information

rID: 25130
Diagnostic certainty: Certain
System: Musculoskeletal
Inclusion in quiz mode: Included

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