Toothpaste sign - extruded intervertebral disc

Case contributed by Dr Ian Bickle

Presentation

Back pain radiating into the right leg with sensory deficit.

Patient Data

Age: 45 years

L5/S1 disc extrusion, in a right para-central position, which is extending cranially.  The thecal sac is significantly effaced, with impingement on the descending S1 nerve root.

All of the lumbar discs with the exception of L1/L2 are dehydrated.

The extruded disc 'squeezed' out like paste from a toothpaste tube

Case Discussion

MRI lumbar spine is one of the most commonest MRI requests.  Huge variation and mis/use of disc terminology.

This is a classic example of an extrude disc demonstrating the toothpaste sign.  The description given due to the resemblance of toothpaste being squeezed out of the tube.

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