L5 root compression caused by degenerative spinal stenosis of the L1-L2 and L2-L3 spaces.

STUDY DESIGN: A severe bilateral L5 root lesion associated with spinal stenosis at L1-L2 and L2-L3 is described. OBJECTIVE: To describe clinical findings and the difficulty in obtaining a correct diagnosis of L5 Root Compression. SUMMARY OF BACKGROUND DATA: The disorder reported in this study has not been reported previously. Only one similar case has been described in the literature: an L5 root compression at L1-L2 caused by disc herniation. METHODS: Diagnosis was obtained by using computed tomography scanning, magnetic resonance imaging, and computed tomography myelography. The findings at L5-S1 were minimal to justify the patient's clinical symptoms, but a detailed study of the upper levels revealed spinal stenosis at L1-L2 and L2-L3, which could have been causing L5 and S1 root compression. A decompressive laminectomy and partial facetectomy in both levels were performed. RESULTS: The patient's pain and claudication disappeared, and clinical symptoms associated with the right L5 root improved. The left L5 root deficit remained stable. CONCLUSION: An unusual case of L5 root compression caused by degenerative stenosis of L1-L2 and L2-L3 is described.

Intradural disc herniation associated with epidural gas.

STUDY DESIGN: A case report of a patient suffering from an intradural herniated disc associated with the presence of epidural gas. OBJECTIVE: To advise spine surgeons of the possible association of intradural disc herniation and epidural gas, to prevent overlooking intradural disc fragments during surgery. SUMMARY OF BACKGROUND DATA: Three cases of this rare association were published previously, something surprising given the relatively rare occurrence of intradural herniations and the presence of epidural gas. METHODS: A case is presented where such an association occurred, on the basis of preoperative examinations and intraoperative findings. The literature is reviewed for cases of herniated discs associated with epidural gas and for intradural herniations. RESULTS: During the open discectomy, after a negative epidural examination, an intradural examination was performed, revealing a disc herniation, which was removed. The patient's postoperative development was satisfactory. CONCLUSION: The possibility of an intradural herniated disc must always be considered when performing an open discectomy on a patient whose computed tomography scan reveals the presence of epidural gas. In the event that no clear disc herniation is found to justify the clinical symptoms or the previous radiologic findings, an intradural exploration may be indicated.