0:01

We've just heard the terminology that I use for

0:05

the description of disc disease and I want to use

0:10

this example for employing that terminology.

0:14

Here at the L5-S1 level,

0:17

we see a disc herniation that is associated with

0:22

compression of the thecal sac.

0:24

And see it on the T1-weighted scan as well.

0:27

So as we look at this,

0:29

we're going to first make a distinction as far as

0:32

whether or not we believe this represents a disc

0:35

protrusion or an extrusion. On the sagittal scan,

0:39

if we use our

0:42

little measuring device,

0:46

it appears as if the portion that is at the base

0:50

in communication with the parent disc is

0:53

wider than any location more distally.

0:57

And therefore, I would use the term protrusion

0:59

based on the sagittal and then move to the axial

1:02

scan, and kind of confirm the same in that this is

1:04

a wide based disc herniation that has a width that

1:15

is wider at the communication with the parent

1:18

disc here than anywhere more distally.

1:20

So at the beginning, we'll be talking about this

1:23

is a disc herniation, it is a protrusion.

1:26

As we look at the axial scan,

1:29

it's pretty clear that this is a disc herniation

1:32

which is compressing the thecal sac,

1:35

as well as the intrathecal nerve roots.

1:38

So, at this axial level of the lateral recess at L5-S1,

1:44

we see the L5 nerve roots getting out.

1:47

However, as we go down a little bit more inferiorly,

1:50

we're going to see that there is compression of

1:52

the thecal sac and the intrathecal

1:54

S1 nerve roots. Looks like, in this case, bilaterally.

1:58

So the term that I'll be using

1:59

is compressing or displacing.

2:01

So disc herniation, protrusion,

2:04

compressing or displacing.

2:06

The next thing we want to talk about is its location.

2:09

The location of the disc herniation is

2:12

centrally, however, as we scroll,

2:15

we see that it does extend into

2:17

the neural foramen as well.

2:20

So a central, as well as right foraminal disc

2:25

herniation, the location of the disc herniation.

2:28

The next thing we're going to talk about is,

2:30

where is the nerve root compressed?

2:32

Well, the nerve root is compressed within the thecal sac,

2:35

as you see here,

2:36

as well as involvement of the foraminal

2:41

disc herniation of the level above.

2:43

So this would be L5 in the foramen

2:46

but S1 in the thecal sac.

2:49

And then, we would talk about the size of it.

2:52

So this looks to, you know, we could measure it,

2:54

but it's greater than two-thirds

2:56

of the spinal canal width.

2:58

And therefore, we would say that there's marked

3:01

spinal stenosis by a large disc herniation.