Presentation
Low back pain, bilateral sciatica.
Patient Data
Spondylodegenerative changes of the lumbar spine. Lowered T2 signal intensity of the lower lumbar discs denoting partial disc desiccation.
Narrowing of L3-4 disc with right para-median disc herniation effacing the ventral epidural fat, indenting the theca and encroaching on the right lateral recess. An oval shaped (0.6 x 0.7 x 1.9 cm) intra-spinal anterior extra-dural lesion is noted, opposite L4 vertebral body and connected to a wide annular tear of L3-4 disc, displaying T1 and T2 iso-intensity to cord and compressing the theca which is displaced to the right side, mostly representing extruded disc rather than a neurogenic tumor.
LV4-5 diffuse disc bulge indenting the anterior theca and encroaching on the inferior aspect of the exit neural foramina.
L5-S1 central and right para-median disc herniation with mild caudal migration, effacing the ventral epidural fat, indenting the theca and obliterating the right lateral recess with encased traversing portion of the right S1 root. Focal T2 hyperintensity is also noted along the posterior aspect of the disc; reflecting acute annular tear.
Case Discussion
The presence of extra-dural disc material, with a broad-dome and narrow neck, connected to obvious annular tear with migration are almost consistent with disc extrusion. If the connection to the native disc is interrupted, it is named disc sequestration.
As an extradural lesion, it exerts a mass effect upon the related lateral neural recess and thecal sac and so significant neurological compressive symptoms. If the imaging features, signal intensity and connection to the native disc are not clear, a contrast-enhanced study may be needed to differentiate it from other possible spinal extra-dural lesions.
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