Presentation
Several months of lower back pain and numbness.
Patient Data
Degenerative changes at the L4/L5 vertebral endplates.
Minor diffuse disc bulge at L3/L4 with a small annular tear in the posterior aspect of the disc.
Massive L4/L5 extrusion completely compressing the cauda equina in the thecal sac.
T12/L1 conus.
Case Discussion
As far as disc extrusions go, this is about as big as it gets. The cauda equina is completely compressed in the by the disc.
Amazingly this was a young patient having an elective MR lumbar spine from the family doctor, not in Accident and Emergency with red flag signs.
Radiological appearances and symptoms can vary hugely, Not infrequently I report lumbar spine studies where the significant radiological findings are on the contralateral side to the patient's symptoms.