lunedì 27 dicembre 2010

Lumbar disc extrusion with a wrapped disc







Findings

There is a left central disc extrusion at L5-S1 that causes mild to moderate left lateral recess narrowing and nerve root displacement without nerve root compression. At this level there is also contrast enhancement traversing the left laminectomy defect and encasing the disc extrusion, consistent with a wrapped disc. There is enhancement in the left lateral recess, suggesting post-operative fibrosis.

Differential diagnosis:
- Wrapped disc
- Peridural fibrosis
- Epidural abscess
- Epidural metastasis
- Nerve sheath tumor
- Disc pseudobulge
- Intervertebral disc protrusion
- Intervertebral disc extrusion
- Recurrent intervertebral disc herniation


Diagnosis: Lumbar disc extrusion with a wrapped disc


Key points: "Wrapped" disc


Disc herniation (protrusion, extrusion, or fragment) may be caused by trauma, repetitive or acute, and are a common source of pain and subsequent back surgery in the general population. In the acute phase, the herniated disc stimulates a fibrovascular response. A "wrapped disc" is the focal herniation (protrusion, extrusion, or fragment) that is encased in vascular scar tissue stimulated by this response and is evident by enhancement on contrast-enhanced T1-weighted images.

Asymptomatic or low back pain and/or radiculopathy are most common in the lumbar spine at L4-L5 and L5-S1. A wrapped disc is a post-surgical sequela, particularly following surgery for spinal stenosis in which the surgical procedure is more extensive, involving a laminectomy and a medial facetectomy.

Best imaging modality: MR (sequences: sagittal and axial T2WI and T1WI, as well as contrast-enhanced axial and sagittal T1WI)
Other imaging modalities: CT, myelography


Imaging findings

MR: Anterior extradural mass contiguous with the disc space extending into the spinal canal
*Contrast-enhanced T1WI: Peripheral enhancement surrounding the disc herniation or fragment with/without central canal, lateral recess, or foraminal stenosis and cord or nerve root impingement. (*most helpful MR sequence)
Non-enhanced T1WI: Isointense to parent disc
T2WI: Iso- to hyper intense to parent disc
General disc hypointensity and height loss at the level of the herniation, as well as postoperative changes (laminectomy defects, etc), degenerative facet disease, and osteophytes, are common associated findings.
CT:
Non-contrast CT: An anterior extradural soft tissue mass that may displace the nerve root / indent the thecal sac
Contrast-enhanced CT: Mild peripheral enhancement of the disc herniation/fragment
Myelography: An extradural mass that indents the thecal sac and nerve root sleeves
Imaging findings of other common differential diagnoses
Peridural fibrosis: Scar within epidural space after lumbar surgery that infiltrates epidural fat, causing homogeneous enhancement that diffusely surrounds the thecal sac and nerve root; increased in T2 signal relative to adjacent disc herniation
Epidural abscess: A distinct fluid collection in the epidural space with peripheral enhancement on post-contrast images, often associated with findings of diskitis
Epidural metastasis: Elongated (cranial-caudal orientation) enhancing mass with osseous involvement and may demonstrate paravertebral extension
Nerve sheath tumor: Avid enhancement surrounding the nerve root, some of which are in a "dumbbell" shape
Disc pseudobulge: Smooth generalized extension of the disc margin without a focal defect due to "uncovering" of disc related to spondylolisthesis
Intervertebral disc protrusion: Anterior extradural mass contiguous with disc space and triangular in shape with broader base than apex; no enhancement
Intervertebral disc extrusion: Anterior extradural mass contiguous with disc space by a "neck," in which this herniated disc material then widens in the epidural space
Recurrent intervertebral disc herniation: Extradural mass contiguous with intervertebral disc margin, demonstrating enhancement peripherally but without central enhancement
Treatment
Conservative: Anti-inflammatory and pain medications, avoid trauma
Surgical: Repeat surgery to remove herniated disc (protrusion, extrusion, fragment)

7 commenti:

  1. A herniated disc surgery in Houston can help overcome back issues and treat them effectively.

    RispondiElimina
  2. If you are undergoing any kind of health or dental problems and are unable to get the right type of treatment anywhere in Dubai then we will suggest you to once reach us at Montreal International Clinic. We have been serving many patients with varied kind of medical problems with the latest technologies. Here you get the consultations booked for free and along with there will be many discounts and offers too. Don't miss the chance to meet the best doctors of Dubai at www.montrealintclinic.com.

    Plastic Surgery Dubai | Laser Hair Removal Dubai | Fraction Laser Dubai | Meso Therapy Dubai

    RispondiElimina
  3. Spine surgery in Mumbai is necessarily preferred for the patient as to stop the further damage to the spinal cord and other kinds of fatal

    RispondiElimina
  4. Amazing post !! This is so informative blog. Keep sharing. if you are looking for Pain Management. Check the Link.
    thank you

    RispondiElimina
  5. I find something in herbal medicine good to share on here with anyone suffering from the disease such as HIV, Herpes, Hepatitis or Chronic Lyme Disease,Parkinson's disease,Schizophrenia,Lung Cancer,Breast Cancer,Colo-Rectal Cancer,Blood Cancer,Prostate Cancer,siva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone ToxicitySyndrome Fibrodysplasia Ossificans ProgresSclerosis,Seizures,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpe ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
    Dementia.
     Lupus as well.Dr Itua herbal made cure my HIV and gave me hope that he can cure all types of diseases I believed him) I do the best of myself that I can do, I went for a program in west Africa about fashion on another side I was HIV positive. I walk through a nearby village for our program schedule then I found a signage notice that says Dr Itua Herbal Center then I asked my colleagues what all about this very man called Dr Itua, She told me that he's a herbal doctor and he can cure all kind of disease i walked to him and explain myself to him as I'm a strangler out there he prepared me herbal medicine and told me how to drink it for two weeks, when I get to my hotel room I take a look at it then says a prayer before I drank it not knowing after two weeks I went to test and I found out I was negative I ran to him to pay him more but he refuses and says I should share his works for me around the globe so sick people can see as well. I'm writing a lot about him this season so that is how I was cured by drinking Dr Itua herbal medicine, He's A caring man with godly heart. Well - everything I decided all go through for me well and how you're going to treat this new aspect to your life. You don't have to suffer alone, and it's okay to ask for help. It also doesn't have to be a constant demon, as you'll get to know your body and yourself in a much deeper way than most people. Take advantage of this, as it will help you appreciate Africa Herbal Made.
    Dr Itua Contact Information.
    Email...drituaherbalcenter@gmail.comWhatsapp Number....+2348149277967        

    RispondiElimina
  6. But Dr. Itua, Traditional Herbal Practitioner in Africa, has cured HIV which is extracted from some rare herbs. It is highly potential to cure AIDS 100% without any residue. Dr Itua herbal medicine has already passed various blogs on how he uses his powerful herbs to heal all kinds of diseases such as. Herpes, HIV,,Cushing’s disease,Heart failure,Multiple Sclerosis,Hypertension,Colo_Rectal Cancer, Diabetes, Hepatitis,Hpv,Weak ErectionLyme Disease,Blood Cancer,Alzheimer’s disease,Bechet’s disease,Crohn’s disease,Parkinson's disease,Schizophrenia,Lung Cancer,Breast Cancer,Colo-Rectal Cancer,Blood Cancer,Prostate Cancer,siva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroqquinolone Toxicity,Brain Cancer,Breast Cancer,Lung Cancer,Kidney Cancer,Syndrome Fibrodysplasia Ossificans ProgresS sclerosis,Seizures,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpe ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,Dementia.,Wart Remover,Cold Sore, Epilepsy, also his herbal boost immune system as well. I'm telling this because he uses his herbal medicine to cure me from hepatitis B and HIV, which I have been living on for 9 months now with no side effects. Herbal Medicine is just as good when drinking it although i have to use the restroom after drinking it which I don't really care about because i just want to get the virus out of my body, I will recommend Dr Itua to anyone sick out here to contact Dr Itua with this following information.Email...drituaherbalcenter@gmail.com  /  
    Whatsapp Or Call...+2348149277967.
    He might be late to respond because he is always busy with patents, but he will surely get back to you with a positive response.

    RispondiElimina
  7. I find something in herbal medicine good to share on here with anyone suffering from the disease such as HIV, Herpes, Hepatitis or Chronic Lyme Disease,Parkinson's disease,Schizophrenia,Lung Cancer,Breast Cancer,Colo-Rectal Cancer,Blood Cancer,Prostate Cancer,siva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone ToxicitySyndrome Fibrodysplasia Ossificans ProgresS sclerosis,Seizures,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpe ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
    Dementia.
     Lupus as well.Dr Itua herbal made cure my HIV and gave me hope that he can cure all types of diseases I believed him) I do the best of myself that I can do, I went for a program in west Africa about fashion on another side I was HIV positive. I walk through a nearby village for our program schedule then I found a signage notice that says Dr Itua Herbal Center then I asked my colleagues what all about this very man called Dr Itua, She told me that he's a herbal doctor and he can cure all kind of disease i walked to him and explain myself to him as I'm a strangler out there he prepared me herbal medicine and told me how to drink it for two weeks, when I get to my hotel room I take a look at it then says a prayer before I drank it not knowing after two weeks I went to test and I found out I was negative I ran to him to pay him more but he refuses and says I should share his works for me around the globe so sick people can see as well. I'm writing a lot about him this season so that is how I was cured by drinking Dr Itua herbal medicine, He's A caring man with a godly heart. Well - everything I decided all went through for me and how you're going to treat this new aspect to your life. You don't have to suffer alone, and it's okay to ask for help. It also doesn't have to be a constant demon, as you'll get to know your body and yourself in a much deeper way than most people. Take advantage of this, as it will help you appreciate Africa Herbal Made.
    Dr Itua Contact Information.
    Email...drituaherbalcenter@gmail.comWhatsapp Number....+2348149277967        

    RispondiElimina