Lateral disc extrusion

Case contributed by A.Prof Frank Gaillard

Presentation

Left sided sciatica

Patient Data

Age: 45 years
Gender: Male
MRI

Lumbar spine

Loss of the normal lordosis with multilevel disc desiccation and height loss. Multilevel facet arthropathy worse at L4-5 and L5-S1. 

T12/L1- L3/4: No neural foraminal compromise or significant disc bulges.

L4/5: Mild spinal stenosis secondary to a combination of facet arthropathy and flavum hypertrophy. A large left sided far lateral disc extrusion with annular fissure is present contacting and displacing the left L4 nerve root lateral to the foramen.

L5/S1: Near complete loss of intervertebral body height with Modic Type II changes. Large central and left paracentral disc extrusion contacting the left descending S1 root in the lateral recess. He nerve root is a little swollen. No neural foraminal compromise of the exiting L5 roots.

The conus ends normally at approximately L1.

Conclusion:

1. Large left far lateral L4/5 disc extrusion displacing the L4 nerve root
2. Large left paracentral L5/S1 disc extrusion contacting the descending left S1 nerve root in the lateral recess.

Case Discussion

Lumbar disc disease is common and one of the leading causes of incapacitation. Accurate description of the findings is important in aiding clinicians in appropriate treatment. 

One of the easiest to miss protrusions is one that is located lateral to the foramen, known as lateral or far-lateral in location. 

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Case information

rID: 23824
Case created: 11th Jul 2013
Last edited: 1st Nov 2015
Tag: spine
Inclusion in quiz mode: Included

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