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Herniated L5-S1 Disk - Case 1

A 39 year-old man developed low back pain radiating down the right leg associated with numbness of the lateral foot.  Examination showed an absent right ankle reflex, weakness of right ankle plantar flexion and knee flexion, and patchy loss of sensation over the right lateral foot and posterior lateral leg.

Show the Herniated Disk                                                         Compare the Right and Left Intervertebral Foramens

T2-weighted MRI scans of the lumbosacral spine; (Left) Sagittal image; (Right) Axial images.  In T2 weighted images, CSF is bright.  Note the large disk herniation between the L5 and S1 vertebral bodies.  On the axial scans, the herniation is posterior lateral, compressing the exiting S1 nerve root, resulting in the clinical symptoms and signs of a S1 radiculopathy.  Note how the foramen is completed occluded. Most disk herniations are posterior lateral, not directly posterior, due to the presence of the tough posterior longitudinal ligament.

Revised 04/23/06.
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