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Case of the Week 88

Case of the Week 88. Courtesy of Bill Hsu, DC, DACBR. History: 20 year old male student with 4 months of LBP and left leg pain and numbness in the S1 dermatome after an injury during a basketball game.

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Case of the Week 88

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  1. Case of the Week 88 Courtesy of Bill Hsu, DC, DACBR

  2. History: • 20 year old male student with 4 months of LBP and left leg pain and numbness in the S1 dermatome after an injury during a basketball game.

  3. What are the abnormal findings? What is the diagnosis? Is the cause of his symptoms seen here?

  4. Answers • Abnormal findings: • A very shallow right ‘C’ lumbar scoliosis is present with the apex at the L1-2 disc space. • Mild narrowing of the L4-5 disc space is noted with a small osseous fragment evident posterior to the L4-5 disc space. • Diagnosis: • Posterior Limbus bone related to disc herniation prior to fusion of the ring epiphysis. • Is the cause of his symptoms seen here? • NO! He has signs and symptoms of an S1 radiculopathy. The problem at the L4-5 level would most likely target the L5 nerve root.

  5. Close up of the area of interest

  6. Here is the follow-up CT scan at the L4-5 level showing the posterior limbus bone and related Schmorl’s node defect in the end plate.

  7. CT slices at the L5-S1 level. What are the abnormal findings? Is this likely related to the presenting complaint?

  8. Answers • Abnormal findings? • A fairly large, broad based, left, postero-lateral disc prolapse is noted at the L5-S1 level obliterating the left S1 nerve root and slightly effacing the thecal sac. It extends into the left IVF. • Are they likely related to presenting complaint? • Yes.

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