Presentation
Right sided sciatica.
Patient Data
Straightening of the normal lumbar lordosis, alignment is otherwise satisfactory on sagittal images. No fracture or focal osseous lesion is seen. No pars defect. The conus terminates at the level of L1.
At T12-L1, L1-2 and L2-3, the posterior disc contours are maintained and there is no central canal or foraminal stenosis. The facet joints are preserved.
L3-4 there is disc degeneration with a central annular tear and a minimal disc bulge. No central canal or foraminal stenosis is seen. At L4-5, there is progressive disc degeneration and loss of disc height.
Large central/right paracentral disc extrusion, measuring 14 mm transverse in size and extending caudally by 2.9 cm. This causes severe central canal and right lateral recess stenosis with compression of the descending right L5 and S1 nerve roots. The disc extrusion contacts the descending left L5 nerve root. Mild facet arthrosis. No foramina stenosis.
At L5-S1, the posterior disc contour is maintained. No central canal or foraminal stenosis is seen. The facet joints are preserved.
Incidental sacral Tarlov cysts at S2.
The visualized portions of the sacroiliac joints have normal appearance. The psoas and paraspinal muscles are symmetric.
Case Discussion
Large L4/L5 central/right paracentral disc extrusion with caudal migration of disc material to the L5-S1 disc space causing severe central canal and right lateral recess stenosis with compression of the descending right L5 and S1 nerve roots. Disc extrusion contacts the descending left L5 nerve root in the lateral recess.
The MRI findings were confirmed at surgery.