Massive L4/L5 disc extrusion with cauda equina compression
Several months of lower back pain and numbness.
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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.
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.