Disc Herniation and Clinical Radicular Disparities (original) (raw)
Related papers
Extreme lateral disc herniation manifesting as nerve sheath tumor Case report
R I O R to the advent of computeri zed tomograp hy (CT) scanning, ex t reme lat e ral disc hern i at i o n s we re ra re ly diag n o s e d. In contrast to classic intra-canal disc hern i ation, ex t reme lat e ral disc hern i ations usu-a l ly present at the upper lumbar levels. This ra rity means t h at few surgeons have had ex t e n s ive ex p e rience with the ex p l o ration of the ex t ra fo raminal area and re m oval of the d i s c. Seve ral cases have been documented 3 , 1 0 , 1 2 in wh i ch a fo raminal or ex t ra fo raminal lesion was diagnosed as a re t ro p e ritoneal neoplasm, intra d u ral tumor, and benign t u m o r, re s p e c t ive ly, but a hern i ated interve rt eb ral disc wa s fo u n d. We present the fi rst case of an ex t reme lat e ral disc h e rn i ation that manifested as an L-3 nerve sheath tumor, and in wh i ch hern i ated disc fragments penetrating the ep i n e u rium of the nerve sheath we re found in the nerve root. We hy p o t h e s i ze that the hern i ated disc damaged the n e u ral ep i n e u rium and allowed the disc fragments to enter the nerve ro o t. Case Report A 42-ye a r-old movie technician developed a sudd e n onset of back pain, wh i ch was part i a l ly re l i eved by ly i n g s u p i n e. He developed sciatic-type left leg pain that awa k-ened him at night. He also had paresthesia along the medi-al aspect of the left knee. On ex a m i n ation, he had difficulty standing upright fro m a fl exed position on his left leg, and there was decre a s e d bulk of the left thigh by 2 cm as compared to the ri g h t. D e c reased sensation to pinpri ck was found in the L-3 der-m at o m e. Lumbar mye l ogram showed small ex t ra d u ra l d e fects of L4–5 and L5–S1. A CT scan perfo rmed by the re fe rring center did not image the L3–4 disc space. Because the clinical findings did not correspond with the ra d i o l ogical ones, a magnetic resonance (MR) image wa s o rd e re d. While awaiting MR imagi n g, the pain decre a s e d, but the left leg numbness and weakness incre a s e d, and his left knee tendon re fl ex was lost. The MR image showed a 1 0.6-cm fusifo rm lesion lat e ral to the interve rt eb ra l fo ramen of the L3–4 disc, on the left side, wh i ch enhanced with gadolinium (Fi g. 1). The lesion was suspected to be a small sch wa n n o m a. A lat e ral ap p ro a ch was used to ex p l o re the region. Th e L-3 nerve root was enlarged in a fusifo rm shape by the lesion. A minimal amount of the most lat e ral part of the facet joint was re m oved to allow a better view of the t u m o r. The capsule of the lesion was opened and the inner p a rt was taken out; it was soft, cru m bly, greyish mat e ri a l. The fro zen section diagnosis was sch wannoma. The inner aspect of the capsule was also taken out, but the wh o l e lesion was not resected because the L-3 nerve root wa s i n c o rp o rated into a large part of the capsule of the lesion. This report discusses the clinical features of a patient who presented with an L-3 radiculopathy in whom magnetic resonance imaging demonstrated what appeared to be a nerve sheath tumor in an extraforaminal location on the L-3 nerve root. A lateral intermuscular approach to excise the lesion was used to preserve the facet joint. Histological examination of the intraneural lesion revealed degenerative disc fragments. The authors hypothesize that the structure of the annulus fibrosus in the upper lumbar region predisposes these regions to lateral herniation. Furthermore, it is proposed that the lateral disc herniation allowed the disc fragments to erode through the epineurium of the neural sheath. This case expands the differential diagnosis of fusiform enlargement of nerves to include disc herniation. KE Y WO R D S • lateral disc herniation • nerve sheath tumor • extreme lateral approach P
Advances in Orthopedics, 2020
Purpose The aim of this study was to find out the correlation between magnetic resonance imaging (MRI) and nerve conduction studies' (NCS) findings in patients with lumbosacral radiculopathy caused by lumbar intervertebral disc herniation. In addition, the study aimed at finding the correlation between the clinical manifestations of lumbosacral radiculopathy and both MRI and NCS. Patients and Methods. The study was a cross-sectional analytic study which included thirty patients with a history suggestive of lumbosacral radiculopathy. Inclusion criteria were as follows: patients who had an MRI confirmed L4/5 and/or L5/S1 intervertebral disc prolapse in addition to one or more of the following (dermatomal distribution of symptoms appropriate with MRI level, presence of motor weakness, sensory impairment, absent ankle jerk, or positive straight leg raising test). All patients underwent clinical assessment and NCS, and their MRI examination was reviewed. The Chi-Squared/Fisher's exact test was used to test the correlation. Results There was a statistically significant correlation between abnormal physical findings and nerve root compression in MRI. Statistically significant correlation was neither found between abnormal physical examination findings and abnormal NCS nor between nerve root compression in MRI and abnormal NCS findings. Conclusion Abnormal neurological examination findings can be used to predict nerve root compression in MRI examination. On the contrary, positive findings of physical examination do not predict abnormal NCS, as well as negative findings do not exclude abnormal NCS; therefore, it is useful to add NCS when MRI findings do not match clinical examination findings or when no neuroimaging abnormalities can be identified.
Far lateral disc herniation evaluated by coronal mr: case series
Turkish Neurosurgery, 2013
The extent of the slice thickness in spinal axial and sagittal magnetic resonance imaging (MRI) is limited. We therefore, propose the idea of using coronal MRI to better delineate lumbar far lateral disc herniations. Six patients with coronal MR images who underwent surgery are presented in this study. Simple 2D vertebral column X-ray and MRI scans were used to diagnose the far lateral herniated disc. Intraoperative findings confirmed our preoperative MRI diagnosis in all patients. Recovery was excellent in all patients. In conclusion, coronal lumbar MRI, a simple and useful technique to reveal the nerve roots in foraminal and/or far lateral (extraforaminal) areas, is a must for accurate diagnosis of foraminal and/or far lateral lumbar disc herniations.
Case: A 29-year-old man presented with right medial arm pain with paresthesia, as well as right-sided ptosis, miosis, and anhidrosis. Magnetic resonance imaging revealed a right paracentral disc herniation at the T1-T2 level. The patient underwent a hemilaminectomy with a medial facetectomy through a posterolateral approach to the T1-T2 disc space, followed by a discectomy. Intraoperative findings were notable for a conjoined nerve root. Conclusion: Although high thoracic disc herniation is rare, its diagnosis should be considered when patients present with radicular arm pain and Horner syndrome. A high index of suspicion should be maintained for nerve root anomalies to limit iatrogenic injury and to ensure successful decompression. T horacic disc herniation (TDH) represents a rare pathology ; it has an annual incidence of 1 in 1,000,000 persons per year 1 and represents <1% of hospital admissions for disc disease 2,3. Most TDHs occur at the T8-L1 levels 3. Upper TDHs are less common because of the relative immobility of the upper thoracic spine and the narrow disc heights in this region 2-5. Clinical presentation of high TDH includes back pain, medial arm pain, myelopathic symptoms, and, potentially, Horner syndrome 3,6-8. We present a patient with a TDH and Horner syndrome who was treated surgically. Intraoperative findings revealed a conjoined nerve root (CNR) at the symptomatic level. The patient was informed that data concerning the case would be presented for publication, and he provided consent. Case Report A 29-year-old man presented with a history of 2 prior anterior cervical procedures (C5-C6 and C6-C7 anterior cervical discectomy and fusion with plating) at an outside institution 2 years prior because of a traumatic injury (C6 lateral mass separation). He presented to the emergency department of our facility with 4 days of worsening right upper-extremity radiculopathy localized to the medial brachium after moving furniture. The patient also noted an intrinsic weakness in the Fig. 1 Axial T2-weighted MRI demonstrating the paracentral T1-T2 disc herniation (arrow).
European Journal of Radiology, 2005
Prospective MR analysis of the cervical spine of 30 asymptomatic volunteers. To evaluate the prevalence of annular tears, bulging discs, disc herniations and medullary compression on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images of the cervical spine in symptom free volunteers. Few studies have reported the prevalence of cervical disc herniations in asymptomatic people, none have reported the prevalence of cervical annular tears on MR images of symptom free volunteers. Thirty symptom-free volunteers (no history or symptoms related to the cervical spine) were examined using sagittal T2-weighted fast spin-echo (SE), sagittal gadolinium-enhanced T1-weighted SE imaging and axial T2(*)-weighted gradient echo (GRE). The prevalence of bulging discs, focal protrusions, extrusions, nonenhancing or enhancing annular tears and medullary compression were assessed. The prevalence of bulging disk and focal disk protrusions was 73% (22 volunteers) and 50% (15 volunteers), respectively. There was one extrusion (3%). Eleven volunteers had annular tears at one or more levels (37%) and 94% of the annular tears enhanced after contrast injection. Asymptomatic medullary compression was found in four patients (13%). Annular tears and focal disk protrusions are frequently found on MR imaging of the cervical spine, with or without contrast enhancement, in asymptomatic population. The extruded disk herniation and medullary compression are unusual findings in a symptom-free population.
MRI Evaluation of Lumbar Disc Degenerative Disease
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2015
Introduction: Lower back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 40 y. MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. Aims and Objective: To evaluate the characterization, extent, and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study design: Cross-sectional and observational study. Materials and Methods: A total 109 patients of the lumbar disc degeneration with age group between 17 to 80 y were diagnosed & studied on 1.5 Tesla Magnetic Resonance Imaging machine. MRI findings like lumbar lordosis, Schmorl's nodes, decreased disc height, disc annular tear, disc herniation, disc bulge, disc protrusion and disc extrusion were observed. Narrowing of the spinal canal, lateral recess and neural foramen with compression of nerve roots observed. Ligamentum flavum thickening and facetal arthropathy was observed. result: Males were more commonly affected in Degenerative Spinal Disease & most of the patients show loss of lumbar lordosis. Decreased disc height was common at L5-S1 level. More than one disc involvement was seen per person. L4-L5 disc was the most commonly involved. Annular disc tear, disc herniation, disc extrusion, narrowing of spinal canal, narrowing of lateral recess, compression of neural foramen, ligamentum flavum thickening and facetal arthropathy was common at the L4-L5 disc level. Disc buldge was common at L3-L4 & L4-L5 disc level. Posterior osteophytes are common at L3-L4 & L5-S1 disc level. L1-L2 disc involvement and spondylolisthesis are less common.
2017
Objective. Quantitative sensorial tests (QST) are used for evaluating specific sensorial nerve function. In this study, QST and magnetic resonance imaging (MRI) findings are compared in lumbar disc herniation patients, and the accuracy of QST data was investigated. Material and Methods. Sixty-four patients between 18 and 70 years of age suffering from radicular pain with positive Lasegue's test were included in this study. Specific criteria included complaints due to L5 discopathy. MRI findings were classified according to the Pfirmann grading system, and QST was applied to the L5 dermatoma of both symptomatic and nonsymptomatic legs of all patients. Vibration detection threshold, heat detection threshold, cold detection threshold, and heat pain detection threshold values were obtained, and MRI findings were classified according to the Pfirmann grading system. Results. When we compared the symptomatic and nonsymptomatic legs of participants, there were significant differences by means of all QST parameters (0 5 0.00). In a comparison of the QST and MRI Pfirmann grading systems, there is also a strong parallel statistical correlation between the Pfirmann grade and QST parameters (P < 0.05). Conclusions. According to the results of our study, QST has an additive effect to MRI for nerve root compression evaluation in the clinical basis, which might enable more sensitive diagnosis and treatment protocol. QST can also be an alternative method for evaluation of nerve root compression in patients who have contraindications for MRI.
An L2/3 Disc Herniation-Related L5 Radiculopathy
Current Health Sciences Journal, 2023
This is an open-access article distributed under the terms of a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Public License, which permits unrestricted use, adaptation, distribution and reproduction in any medium, non-commercially, provided the new creations are licensed under identical terms as the original work and the original work is properly cited.