Massive L4/L5 disc extrusion with cauda equina compression

Case contributed by Dr Ian Bickle


Several months of lower back pain and numbness.

Patient Data

Age: 30 years
Gender: Female

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.

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Case information

rID: 86358
Published: 30th Jan 2021
Last edited: 7th Feb 2021
Inclusion in quiz mode: Included

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