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25b - Answer: Acute low back pain with saddle anesthesia

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

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Case Report

HISTORY: Acute low back pain with saddle anesthesia.

TECHNIQUE:  Sagittal T1 weighted, sagittal T2 weighted, sagittal STIR, axial T1 weighted, and axial T2 weighted scans were performed through the lumbar spine.

COMPARISON: CT lumbar spine 11/30/2013

FINDINGS:
Normal alignment of lumbar spine. Vertebral body height is maintained.
Narrowing of L5-S1 disc space with Modic type I endplate changes.
There is a round-shaped T1/T2 hyperintense lesion in the posterior aspect of the L2 vertebral body on the left with signal suppression on STIR sequence, compatible with hemangioma or fat island.

The conus medullaris is normal terminating at an appropriate level.

At L1-L2, there is no significant spinal canal or neural foraminal stenosis.

At L2-L3, there is minimal disc bulge indenting the anterior aspect of the thecal sac and ligamentum flavum hypertrophy. No significant spinal canal stenosis. Mild left neural foraminal narrowing from facet arthropathy.

At L3-L4, there is disc bulge and ligamentum flavum hypertrophy contributing to mild spinal canal stenosis. Mild narrowing of bilateral subarticular recesses without evidence of nerve root compression. Mild bilateral neural foraminal narrowing, left greater than right, from facet arthropathy.

At L4-L5, there is disc bulge indenting into anterior aspect of the thecal sac and ligamentum flavum hypertrophy resulting in mild spinal canal stenosis. Mild narrowing of bilateral subarticular recesses. Bilateral neural foraminal narrowing from facet arthropathy.

At L5-S1, there is a large disc extrusion resulting in severe narrowing of the spinal canal with compression and posterior displacement of the cauda equina nerve roots. Severe narrowing of bilateral subarticular recesses with compression of bilateral S1 traversing nerve roots. The herniated disc is in contact with right L5 exiting nerve root. Moderate right and mild left neural foraminal narrowing secondary to facet arthropathy.

IMPRESSION:

Large disc extrusion at L5-S1 with severe spinal canal stenosis, and compression of the cauda equina nerve root and bilateral S1 traversing nerve roots. 

LESSON 6, TOPIC 15

Case Challenge: Spine MRI Cases - I-MED Study

Content reviewed: May 12, 2022