Presentation
Back pain and sciatica.
Patient Data
L3-4 diffuse posterior disc bulge inclined to left side encroaching upon exit foramina. It shows a concentric annular tear that is connected to a left paracentral extruded disc material encroaching upon the left lateral recess. It is caudally migrated along the posterior vertebral border of L4. It exerts moderate spinal canal stenosis with proximal redundancy of cauda equina nerve roots.
L4-5 diffuse posterior disc bulge, indenting ventral thecal spect and partially encroaching upon exit foramina, more on left side. Small central radial annular tear is seen with no extruded disc material
L5-S1 diffuse posterior disc bulge, indenting ventral thecal spect and partially encroaching upon exit foramina. It shows right posterolateral disc extrusion with caudal migration and radial annular tear, encroaching upon right lateral recess and traversing right S1 nerve root.
Case Discussion
The extruded L3-4 disc material is connected to an annular tear and caudally migrated along the posterior border of L4 vertebral body, referred to as the toothpaste sign.
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