0:00

For this case,

0:01

I'm going to ask you to ignore the big

0:04

honkin' disc herniation at L5-S1

0:07

and the slight retrolisthesis

0:10

of L5 with respect to S1.

0:14

This patient had a large

0:18

sequestrated disc that was from the L5-S1 level

0:23

and extends, as you can see, into neural foramen.

0:26

We'll see that in just a moment.

0:27

But what I really wanted to emphasize was this

0:30

little finding here, which is the high signal

0:33

intensity in the annulus on the T2-weighted scan and

0:39

the STIR image. It's focally located in the annulus.

0:46

It seems to be associated with a slight disc bulge.

0:49

And on the T1-weighted scan, we really

0:52

don't see very much at all.

0:53

This patient had a post-gadolinium enhanced scan as well.

0:58

And let me just magnify this to a similar degree.

1:04

And what you notice with this example on the

1:09

post-gadolinium enhanced scan is that there is

1:12

focal enhancement in that L4-L5 annular fissure.

1:16

And this is typical of annular fissures.

1:19

Once again,

1:19

to reiterate, the presence of the high signal

1:22

intensity on the T2-weighted scan

1:25

and/or the presence of contrast enhancement on the

1:30

post-gad T1-weighted scan, should not in any way imply

1:34

the age of the annular fissure.

1:36

This can occur and persist for years after the

1:40

insult that led to the annular fissure.

1:43

So just to complete this evaluation, we

1:47

should look at the disc herniation.

1:50

So on our post-gadolinium enhanced scan, you see that

1:55

there is peripheral enhancement

1:58

around a non-enhancing area

2:01

associated with that L5-S1 disc herniation.

2:05

I think maybe I'll just window this a

2:09

little bit brighter. There we go.

2:11

And you can see that that material extends into

2:14

the neuroforamen and is involving that

2:18

S1 nerve root in the neuroforamen.

2:22

This is also seen on the T2-weighted scan

2:27

as an intermediate signal intensity tissue

2:34

that is from the disc herniation with

2:37

a free fragment in the neuroforamen.