1. Case of the Week 88 Courtesy of Bill Hsu, DC, DACBR

2. History: History: 20 year old male student with 4 months of LBP and left leg pain and numbness in the S1 dermatome after an injury during a basketball game. 20 year old male student with 4 months of LBP and left leg pain and numbness in the S1 dermatome after an injury during a basketball game.

3. What are the abnormal findings? What is the diagnosis? Is the cause of his symptoms seen here?

4. Answers Abnormal findings: Abnormal findings: A very shallow right ‘C’ lumbar scoliosis is present with the apex at the L1-2 disc space. A very shallow right ‘C’ lumbar scoliosis is present with the apex at the L1-2 disc space. Mild narrowing of the L4-5 disc space is noted with a small osseous fragment evident posterior to the L4-5 disc space. Mild narrowing of the L4-5 disc space is noted with a small osseous fragment evident posterior to the L4-5 disc space. Diagnosis: Diagnosis: Posterior Limbus bone related to disc herniation prior to fusion of the ring epiphysis. Posterior Limbus bone related to disc herniation prior to fusion of the ring epiphysis. Is the cause of his symptoms seen here? Is the cause of his symptoms seen here? NO! He has signs and symptoms of an S1 radiculopathy. The problem at the L4-5 level would most likely target the L5 nerve root. NO! He has signs and symptoms of an S1 radiculopathy. The problem at the L4-5 level would most likely target the L5 nerve root.

5. Close up of the area of interest

6. Here is the follow-up CT scan at the L4-5 level showing the posterior limbus bone and related Schmorl’s node defect in the end plate.

7. CT slices at the L5-S1 level. What are the abnormal findings? Is this likely related to the presenting complaint?

8. Answers Abnormal findings? Abnormal findings? A fairly large, broad based, left, postero- lateral disc prolapse is noted at the L5-S1 level obliterating the left S1 nerve root and slightly effacing the thecal sac. It extends into the left IVF. A fairly large, broad based, left, postero- lateral disc prolapse is noted at the L5-S1 level obliterating the left S1 nerve root and slightly effacing the thecal sac. It extends into the left IVF. Are they likely related to presenting complaint? Are they likely related to presenting complaint? Yes. Yes.