Presentation
Sports injury some weeks ago, now very severe back and left leg pain with foot drop
Patient Data
Reduction in disc space height at L5/S1 associated with extruded and sequestrated disc material in the epidural space compressing the left S1 and S2 nerve root sheaths. Note the defect in the annulus allowing the nuclear material to leak out (arrow)
Public domain image. Original file: https://commons.wikimedia.org/wiki/File:Toothpaste.jpg
Case Discussion
This study shows two features of extruded and sequestrated disc material. The first is the toothpaste sign of nucleus pulposus being squeezed out from the central disc into the epidural space. The second is the slightly different T2 signal of the annulus (lower) and the extruded/sequestrated nucleus having a slightly higher signal intensity. This is seen on both axial and coronal sequences.
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