Use correct nomenclature: Location / Herniation type
Describe effect on nerves: Contacted / compressed / deviated
Don't forget to check: Extra-foraminal zone
Case 1: Degenerative synovial cyst from facet joint
also has circumferential disc bulges
Case 2: annular fissure
don't call annular tear.
Herniations
Case 3: Disc protrusions
L4/5, L5/S1 disc dessication and loss of heights
L4/5 small central disc protrusion not contacting any nerve roots
L5/S1 right paracentral disc protrusion, contacting right traversing S1 nerve root
Case 4: Disc protrusions
L5/S1 desiccated disc with loss of height
Left paracentral disc protrusion in the subarticular zone, contacting S1 left nerve root
Case 5: Effacement of neural foramen
Effacement of the neural foramina
Disc protrusion within the foraminal zone, with hyperintense disc material effacing the neural foramen
Note: often a foraminal lesion needs to be an extrusion to go up and contact the foraminal nerve root.
Case 6: Extraforaminal impingement
L4/5 L5/S1 disc desiccation and loss of heights
Extraforaminal disc protrusion on the leeft impinging the exiting nerve root
Case 7: Disc extrusion
Descending disc extrusion within the subarticular zone
Disc material can be brighter than the parent disc.
Case 8: Disc sequestration
Not connected to parent disc.
Sometimes contrast given to confirm peripheral enhancement which would be the sequestered disc. as opposed to an enhancing tumor eg. meningioma schwannoma
Case 9: Large disc extrusion L4/5
Case 10: Dorsal epidural disc sequestration.
Contrast given showing the peripheral enhancement
Case 11: Just ddx showing a schwannoma contrasting appearance to a sequestered disc which completely enhances rather than just peripherally.
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