0:00

This is a patient who has degenerative

0:02

disc disease at multiple levels.

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But I want to emphasize the L2-L3 level again so

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that we are comfortable with the

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terminology that is utilized.

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As we scroll through the T1-weighted scans,

0:15

we come to the right neural foramen and we see

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that there is disc material that is extending into

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the inferior portion of the right neural foramen.

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You can compare that to the left neural foramen.

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And this is seen both on the STIR images

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as well as the T1-weighted scan.

0:39

How would we describe this L2-L3 disc herniation?

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So this is the axial scan.

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I'll just place the cursor localizer for just a

0:52

moment and you can see that we're going

0:53

through this L2-L3 disc level.

0:57

And what we see is at the impure aspect of

1:00

the neural foramen, we have disc material.

1:03

I'm going to use my little magic marker here.

1:07

So what I'm referring to is this low signal

1:10

intensity tissue which is extending

1:13

out into the right neural foramen.

1:14

And you notice that overall, the patient

1:16

has a diffused disc bulge.

1:18

However, there is something more focal that

1:21

is identified right there.

1:23

So we could put a little X right on this disc

1:26

material and say we have a herniation.

1:29

How would we describe this?

1:31

So this is clearly in the neural foramen on the right side.

1:36

Some might argue that it's extending a little bit

1:38

into the far lateral zone beyond the neural foramen.

1:41

So a right foraminal and far lateral disc herniation.

1:49

And we next want to characterize the size of this

1:53

and what it's doing to the nerve roots.

1:56

So if we look on the T1-weighted scan, which in...

1:59

when I'm looking at foraminal disc herniations, I like

2:02

using the T1-weighted parasagittal images

2:05

because there is foraminal fat.

2:08

If we look on the STIR image going out to the

2:11

right side, it's kind of hard to distinguish

2:14

everything in here because the foraminal fat and

2:17

the disc herniation are simulating the same signal

2:19

intensity. You see some of the nerve root here.

2:24

But making the assessment of that size and degree

2:28

of stenosis, of that right neural foramen, is better

2:33

seen, in my opinion, on the T1-weighted scan.

2:37

So here we have our neural foramen, and you see the

2:40

nerve root within the neural foramen,

2:42

as well as the neural foraminal fat.

2:45

And we fortunately have the level below at the

2:48

L3-L4 level and the L4-L5,

2:51

and L5-S1 level to compare with.

2:54

When we have disc herniation that is seen

2:56

extending inferiorly, we note that the nerve root

3:00

in the foramen, at no point, is in contact with

3:04

the disc, and therefore this is a non-compressive

3:09

right foraminal and far lateral disc herniation.

3:13

We next want to make the assessment of the

3:15

degree of stenosis of the neural foramen.

3:18

So for this again,

3:20

we're going to make that assessment about

3:22

whether it's one third encroached upon,

3:24

one third to two thirds encroached upon,

3:27

or greater than two thirds encroached upon,

3:29

to use the terms mild, moderate and severe, respectively.

3:34

In this situation, I would be calling this a mild

3:38

foraminal stenosis.

3:41

I might say mild to moderate if I thought it's

3:44

getting towards that one third

3:46

dash, you know, 33%, 34% degree.

3:51

So although on the axial scans, we're kind of

3:55

impressed with the size of this disc herniation,

3:58

when we actually look at the degree to which

4:01

the nerve root is impinged upon and/or

4:05

the foramen is narrowed,

4:07

it actually does not have the same

4:10

clinical import, I would suggest,

4:14

than the size of the disc herniation.

4:16

So in the end, what's our terminology?

4:20

We would say that there is an L2-L3 right foraminal

4:24

far lateral disc herniation.

4:27

which is not compressing the foraminal right L2 nerve root,

4:35

and which causes mild to moderate foraminal stenosis.