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A 29 year-old man developed low back pain radiating to the right anterior thigh. Examination showed an absent right knee reflex, weakness of right hip adduction and knee extension. There was loss of sensation over the right anterior thigh and medial calf.
(Left) Sagittal T2 weighted MRI scan of the lumbosacral spine; (Right Upper) Axial T2 weighted image at L3-4; (Right Lower) Axial T2 weighted image at L5. In T2 weighted images, CSF is bright. Note the large disk herniation between the L3 and L4 vertebral bodies. On the axial scans, the herniation essentially obliterates the CSF compared to a comparable level just below (right lower). If this herniation were to enlarge, this patient would be at risk for developing a cauda equina syndrome.
The Electronic Curriculum is copyrighted 1998, Case Western Reserve University School of Medicine.