Lumbar foraminal disc extrusion

Case contributed by Joachim Feger

Presentation

Pseudo-radicular back pain radiating into the left thigh.

Patient Data

Age: 60 years
Gender: Female

Axial images were acquired at the L1/2 to L3/4 disc levels.

Uncontained disc herniation at the L2/3 disc level,  extending horizontally from the left subarticular zone into the left foraminal zone consistent with a disc extrusion with migration/sequestration of disc material into the left foramen.

Posterior displacement of the left L2 nerve root.

Mild effacement of the left anterolateral thecal sac.

Additional findings:

Mild contained disc herniation at the L3/4 disc level in the right subarticular/foraminal zone consistent with a disc protrusion.

Thickening of the ligamentum flavum at disc level L1/2 to L4/5 level.

Annotated image

Key findings:

  • uncontained disc material in the left L2/3 foraminal zone (red arrowhead)

  • posterior displacement of the left L2 nerve root (blue arrow), which looks altered and deformed if compared to the other nerve roots

Case Discussion

Uncontained disc extrusion with sequestration and migration into the left foraminal zone.

In the absence of any weakness, symptoms suggestive of cauda equina syndrome and any other neurological deficit patient was treated conservatively and symptoms have improved in the meantime.

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