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Sequestered lumbar disc

Case contributed by Dr Ian Bickle

Presentation

Worsening right sciatica for 2 weeks. Post void bladder scan of 212mLs, r/o CES.

Patient Data

Age: 55 years
Gender: Male
MRI

Diffuse L5/S1 right paracentral disc protrusion. The disc partially fills the right lateral recess with effacement of the right side of the thecal sac. Immediately caudal to the disc space in the right lateral recess is an 8 mm well-delineated focus of intermediate signal identical to the partially dehydrated L5/S1 disc, suggestive of sequestrated disc. This combined with the disc protrusion is compressing the descending right S1 nerve root.

Minor narrowing of the right exit foramen, but no L5 nerve root impingement.

The remaining levels are normal. T12/L1 conus. No cauda equina impingement.

 

Case Discussion

MRI of the lumbar spine is common.   Disc pathology on this large volume is common.

Disc sequestration is not that common at all and almost always means surgery rather than conservative management.

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