Presentation
Backache radiating to left side.
Patient Data
Hyperintensity / edema is seen involving inferior endplate of L4 and superior endplate of L5 vertebral bodies with no significant erosions, no obvious pre/paravertebral or epidural soft tissue.
Concentric bulge, left foraminal extrusion of L4-L5 disc is seen with ligamentum flavum thickening and facetal arthropathy, severely compressing left neural foramina, moderately compressing central canal, bilateral lateral recesses and mildly compressing right neural foramina.
Other degenerative changes like marginal osteophytes, disc dessication, ligamentum flavum and facetal hypertrophic changes are also seen.
Case Discussion
Findings suggest likelihood of Modic type I end plate changes. DWI shows the so called 'claw sign' which refers to a pattern of hyperintensity seen in degenerative changes in the spine. The presence of the claw sign makes spondylodiscitis less likely.
Foraminal disc extrusion explains the patient's complaints.