This topic contains 5 replies, has 2 voices, and was last updated by 
Anonymous September 5, 2018 at 8:39 am.
-
Posts
-
AnonymousNever seen this disc presentation at L5-S1 before and cannot find an example of it online. The only way it makes sense to me is that there are torn annular fibers and the nucleus pulposus is leaking through those tears. Anyone seen this before or have a name for this?
Carl Nottoli, DC
Your analysis is correct. This is a disc herniation. The disc material just happens to still contain a lot of hydration so you can visibly see it migrate…she is 17. There also appears to be L5 retrolisthesis on S1. Correlate with your patient findings.
Keith Puri, DC
I agree with Carl. This is a pic of an annular tear or more specifically a radial fissure that was taken from the annular tear page on chirogeek.com. The HIZ’s look similar, although yours travels more posterior and has likely progressed to a contained disc protrusion secondary to a near full thickness radial fissure.
The Lumbar disc nomenclature: version 2.0 review article recommends against using the term ‘tear’ recommends ‘fissure’ instead. It states “Use of the term ‘‘tear’’ can be misunderstood because the analogy to other tears has a connotation of injury, which is inappropriate in this context. The term ‘‘fissure’’ is the correct term. Use of the term ‘‘tear’’ should be discouraged and, when it appears, should be recognized that it is usually meant to be synonymous with ‘‘fissure’’ and not reflective of the result of injury. ”
https://www.chirogeek.com/annular%20tears/annularTears.htm
https://www.thespinejournalonline.com/article/S1529-9430(14)00409-4/pdf
AnonymousThanks for the input, Carl and Keith. I had just never seen a disc herniation present like that, but because herniations like this are in younger and more hydrated discs, it makes sense that you don’t see them as often. Yeah this was a 17 year old female volley ball player. She also had disc degeneration from T12-L2 discs. It was a mess. Thanks again.
William Brady, DC
Great case. Great job answering everyone. The next level question is “How does a 17 year old get a large tear (or fissure if you prefer) with herniation? Carl nailed it by commenting on the retrolisthesis of L5 on S1. This structural arrangement will crush even a well hydrated young disc! This structure will not tolerate loads with lumbar extension and jumping (as in volleyball). Most providers would have missed this finding because they see the disc and stop looking.
Out of curiosity, what did the radiology report say?
Thanks for posting Caleb
AnonymousI have not gotten the report yet as this was taken a month ago prior to her coming in, but the doctor that ordered it told them that there was a schmorls node in upper L/S (which there was) and a really SMALL disc herniation and that neither of those were important for her case and the MRI didn’t show much. It is clear the ordering physician screwed up badly and it cost this girl, but not sure if the radiologist failed to comment or not. I’m still interested in getting the report and will do my best to follow up here.
You must be logged in to reply to this topic.