Lumbar disc extrusion

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Case
A 35-year-old male player presents with an acute onset of low back pain after lifting some luggage. He experienced an acute onset of lumbar-region pain with no significant referral. He describes a history of “sciatica” affecting his right leg three years before. This resolved spontaneously over three months.

On examination there was a loss of the normal lumbar lordosis, marked restriction in lumbar movements and diffuse lumbar tenderness. He had a normal lower limb neurological examination.

Findings
MRI images from three years previously (when he had right sided sciatica) show a large right sided paracentral disc extrusion at L4/5. This tracks for a 26mm craniocaudal length along the L4 posterior vertebral body margin. The superior component of this disc prolapse compresses the right L4 nerve root along its descent proximal to its neural foramen, while the inferior component of the prolapse compresses the right L5 nerve root within its lateral recess. The central canal remains patent with no cauda equina compression.

Images from the current presentation show that the disc extrusion has resolved. There is very mild low signal scarring/fibrosis in the anterior epidural space related to this old injury. There is now a moderate loss of disc height and signal at this level with mixed Modic type I and II endplate changes There is a new caudal right paracentral extrusion extending posterior to the L5 level body measuring 8 x 4 x 15 mm (TV x AP x CC).

Discussion
This player’s back pain resolved with a short period of physiotherapy and the use of some simple analgesics. He was able to return to all normal activities over a period of about four weeks. He was advised to continue with core stability and flexibility exercises.

A number of studies have evaluated the natural history of lumbar disc extrusions. These have shown that even large extrusions, as seen in this player, will spontaneously resolve in the majority of cases. Serial MRI’s have shown that most patients will have a reduction in the size of the herniated disc, with about three quarters having complete resolution. The improvement in the radiological findings is often also associated with improvements in symptoms and function. As a result clinicians should consider whether patients can be managed with supportive treatment, rather than with early surgery.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Cesar Rodrigo Neyra Pangalima
27 July 2020 0:00

Totalmente de acuerdo, de hecho si se trata de una lumbalgia aguda el tratamiento es fortaleciento de los musculos toracoabdominales core, lumbares. Como analgesico paracetamol , kinesiologia localizada. Y buscar el punto de inicio del dolor y trabajar desde el modelo biopsicosocial.
La mayoria de las veces las resonancias van a encontrar patologia que no necesariamente esta relacionada con la lesion.
Si tener en cuenta algunas banderas rojas

Bangoura
Bangoura
28 July 2020 15:48

L EXTRUSION DU DISQUE LOMBAIRE OU HERNIE DISCALE EST UNE PATHOLOGIE FREQUEMENT RENCONTREE EN MEDECINE.
ELLE PEUT ETRE RESPONSABLE DE LA COMPRESSION D UNE OU PLUSIEURS RACINES NERVEUSES.
EN PLUS DE LA RADIOGRAPHIE L IRM EST L EXAMEN DE CHOIX.
DANS LA PLUS PART DES CAS LE TRAITEMENT CONSERVATEUR REPOSE SUR LA PHYSIOTHERAPIE LE MASSAGE LES ANTALGIQUES LES AINS DES CORTICOIDES EN INFILTRATION LOCALE LA ZONE DE PREDILECTION EST SOUVENT LA L5 S1.
APRES 4 A 6MOIS DE TRAITEMENT MEDICAL SANS SUCCES AVEC DES DOULEURS RADICULAIRES TRES RAPPROCHEES UNE INTERVENTION CHIRURGICALE S IMPOSE.