Thoraco-Lumbar Disc Disease

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FACTS

Mechanical pathology: flexion and axial loading
 
Key principle: Disc Herniation Types and Traversing vs. Exiting Nerve Roots 
Herniation Type
Nerve Roots Impacted
Example
Central / Paracentra
traversing nerve root (nerve roots below)
L4-5 disc affects L5/S1 nerve root
Far Lateral / Foraminal
exiting nerve root(nerve root at that level)
L4-5 disc affects affects only L4 nerve root
notion image
 

HPI

 

PHYSICAL EXAM

IMAGING

 
A/P
Surgical options:
  • normal sagittal alignment, facet anatomy → MCD
 

Examples

A 65 year old male who presented with R LBP radiating to buttock with subjective leg weakness showing a Right eccentric L3-4 disc extrusion causing severe compression of thecal sac.
A 65 year old male who presented with R LBP radiating to buttock with subjective leg weakness showing a Right eccentric L3-4 disc extrusion causing severe compression of thecal sac.