Lumbar disc herniation and spinal canal stenosis

Case contributed by Dr Balint Botz

Presentation

Chronic lumbar pain and left lower limb radiculopathy. Disc herniation?

Patient Data

Age: 55 years
Gender: Male
  • Lumbar lordosis diminished. Moderate degenerative changes. 
  • Diffuse dehydration and flattening of depicted intervertebral discs.
  • Caudally oriented L4-5 disc herniation, primarily affecting the left subarticular zone, which compresses the ipsilateral descending nerve root.
  • Slightly above the hernia the spinal canal is narrowed to an AP diameter of 6 mm, CSF space around the nerve roots has become virtual. 
  • Wide bulge of the L5-S1 disc with a central band of T2 hyperintensity indicating annular fissure
  • Status post prior left kidney lower pole resection. 

Case Discussion

The direct compression caused by the L4-5 disc herniation explains the predominantly left-sided symptoms, whilst the spinal canal stenosis affects multiple descending nerve roots bilaterally. 

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