RADIOLOGY

GROUP 1 - MSK CT MRI

ARCENAL - CUENCA - JUANE - OPULENCIA - PUERTO
CASE
A case of 50-year-old man with posterior disk bulge at L5-S1 with bilateral severe neural
canal narrowing, who presents to the clinic with a chief complaint of difficulty in standing up.

1 year PTC, patient complains of lower back pain. He took Ibuprofen (Advil) 200mg once a
day, which provided him temporary relief. No consult done.

3 months PTC, patient still complains lower back pain that is radiating down to his buttocks
and legs (both sides). The pain is characterized as burning or tingling. He still took Ibuprofen
(Advil) 200mg once a day which provided him temporary relief. Still no consult done.

1 day PTC, patient still complains the symptoms above but now with associated weakness,
numbness, and difficulty moving the leg and foot. The pain is characterized as shooting pain
that makes him difficult to stand up.
EXPECTED PHYSICAL FINDINGS
The usual presentation of patients with disk bulge at L5-S1 with bilateral severe neural canal
narrowing: low back pain and bilateral leg symptoms

Vertebral and disc pain from L5-S1 may occur suddenly following an injury or gradually
develop over a period of time. Typically, a dull ache or sharp pain may be felt in the lower
back. Discogenic pain is typically worsened by prolonged sitting, standing in one place, and
repetitive lifting and bending activities. Compression of the L5-S1 spinal nerve root may
cause radiculopathy symptoms or sciatica, characterized by:

➔ Pain, generally felt as a sharp, shooting, and/or searing feeling in the buttock, thigh,
leg, foot, and/or toes
➔ Numbness in the foot and/or toes
➔ Weakness in the leg and/or foot muscles and an inability to lift the foot off the floor
(foot drop)
➔ Incontinence
SPECIFIC IMAGING FINDINGS (Radiograph, CT and MRI)
X-ray imaging:

● Play a relatively inexpensive role in

confirming the suspicion of the presence of a
herniated disc
● If a suspicion is strengthened, other methods
are used to provide final confirmation

CT scan:

● It can show the shape and size of the spinal

canal, its contents, and the structures around
it, including soft tissues.
● Visual confirmation can be difficult with CT
scan
SPECIFIC IMAGING FINDINGS (Radiograph, CT and MRI)

MRI Findings:

● Lumbar spine showing

bilateral foraminal
stenosis due to disc
herniation
TREATMENT OPTIONS
NONSURGICAL TREATMENTS
● Medication – NSAIDS are usually tried first
for pain stemming from L5-S1; For more
severe pain, prescription medication, such as
opioids, tramadol, and/or corticosteroids may
be used
● Physical Therapy - help stabilize the back
and keep the muscles and joints
well-conditioned for long-term relief, while
also providing a healing environment for the
tissues in the lower back
● Chiropractic manipulation - may help
relieve pain stemming from L5-S1
● Self-care – Heat & Ice, Bed rest
INJECTION TREATMENTS
● Lumbar epidural steroid injections. -
help decrease inflammation and reduce
the sensitivity of nerve fibers to pain,
generating fewer pain signals
● Radiofrequency ablation - A part of the
pain-transmitting nerve is heated with a
radiofrequency needle to create a heat
lesion -> prevents the nerve from sending
pain signals to the brain
SURGICAL TREATMENTS
● Microdisectomy
● Laminectomy
● Foraminotomy
● Facetecttomy
● Lumbar interbody fusion
TREATMENT OPTIONS
MODERATE CASES SEVERE CASES

● over-the-counter pain relievers such as ibuprofen (Motrin ● laminotomy or laminectomy, which is removal of the
IB, Advil), naproxen (Aleve), or acetaminophen (Tylenol) bone spurs, scars, or ligament causing the
● prescription pain relievers, like oxycodone (Roxicodone,
narrowing
Oxaydo) or hydrocodone (Vicodin)
● foraminotomy, or enlarging the foramina
● anti-seizure medications that help relieve nerve pain,
● laminoforaminotomy, which involves both of these
such as gabapentin (Neurontin) and pregabalin (Lyrica)
methods
● corticosteroid injections to reduce inflammation
● Physical therapy can also help strengthen the
surrounding muscles, improve your range of motion, For herniated disks, your doctor might perform surgery to
stretch out the spine, and correct your posture.
remove the disk.