Large lumbar disc prolapse

Case contributed by Dr Ian Bickle

Presentation

Low back pain and right leg cramping and pain with paresthesia since March following lifting a box. Tried some exercises but no help. No improve. Has give way feeling in leg right, needing medication for sleep. struggle with walking, bending. Reduced ROM lumbar, no sensory loss, weakness in right leg particularly noted in calf [unable to lift up unilateral]. Slump +ve. Checking for L5/S1 nerve impingement, compression and disc bulge. ? conservative vs neurosurgery.

Patient Data

Age: 30 years
MRI

Large central/right paracentral disc prolapse at L5/S1, impinging on the descending right S1 nerve root, abutting the left S1 nerve root and causing severe central canal stenosis.

No impingement of the exiting L5 nerve roots.

The remaining disc levels are normal.

L1 conus.

Case Discussion

Large L5/S1 disc prolapse with right S1 nerve root impingement.

A striking example of disc prolapse. You can literally feel the pain from the compression on the descending S1 nerve root.

A good candidate for surgical treatment.

A couple of practical points from this case.

  1. when you can see the disc prolapse on the localizer its likely to be a biggy
  2. compare and contrast the axial T2 and T1 images.  Although many protocols only do an axial T2, in cases like this the axial T1 for me really shows the nerve root compression in a more impressive format

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