![]() ![]() When there is a lack of correlation between the exam findings and imaging studies, electrodiagnostic testing may be employed. Often, a far lateral disc herniation can be missed when not specifically looking for it. MRI is a triplanar modality that necessitates utilizing the axial, sagittal, and coronal sequences. The sagittal sequences can demonstrate far lateral disc herniations with the foramina. The coronal sequence shows nerve roots and foraminal and extraforaminal regions where a far lateral disc herniation occurs. Axial T2 w/o contrast MRI lumbar spine the same patient shows compression of the right exiting S1 nerve root, which has caused this patient to experience right S1 radiculopathy.Įnsure that you evaluate the MRI with the patient’s clinical exam in mind. Axial MRI of the lumbar spine w/o contrastĪ. Sagittal T2 w/o contrast MRI lumbar spine shows a large 9 mm L5/S1 paracentral disc protrusion with mass effect on the thecal sac.ī. T2 sagittal MRI of the lumbar spine w/o contrast B. ![]() The diagnosis of the causative agent and subsequent treatment starts with a thorough physical exam.Ī. It may be related to disc bulging or herniation, facet or ligamentous hypertrophy, spondylolisthesis, or even neoplastic and infectious processes. ![]() By definition, radiculopathy describes pain that radiates down the legs and is often described by patients as electric, burning, or sharp. The most common underlying cause of radiculopathy is irritation of a particular nerve, which can occur at any point along the nerve itself and is most often a result of a compressive force. In the case of lumbar radiculopathy, this compressive force may occur within the thecal sac, as the nerve root exits the thecal sac within the lateral recess, as the nerve root traverses the neural foramina or even after the nerve root as exited the foramina. Patients commonly present with back pain that is associated with their radiculopathy. Degenerative spondyloarthropathies are the primary cause of lumbar radiculopathy. In the general population, there is a male preponderance. Females have a higher risk in certain populations, with physically demanding careers such as service in the military. Its prevalence has been estimated to be 3%-5% of the population, affecting both men and women. Age is a primary risk factor, as it occurs secondary to the degenerative process within the spinal column. Symptoms typically begin in midlife, with men often affected in the 40s while women are affected in the 50s and 60s. Lumbar radiculopathy is one of the most common complaints evaluated by a spine surgeon. ![]()
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