Overview

• A 35 year old lady presented with severe onset back and bilateral radicular leg pain, left leg worse affected than the right. She also reported urgency of micturition and some weakness of the left leg. On examination she had signs suggestive of a lumbar disc prolapse.
• She went on to have an MRI scan of the lumbar spine
• What would these signs likely include?
• Label the MRI scan, pointing out abnormalities

The patient went on to undergo a microdiscectomy

• After the initial post operative period, she went on to make a steady recovery, although she continued to report low grade low lumbar back pain and intermittent spasms down her legs.
• Seven months later, she presented to the spinal team once again with a severe return of bilateral burning pain affecting both legs and issues with bladder control and poor balance. She was complaining of severe parasthasiae affecting both legs and feet.
• She went on to have another MRI scan of the lumbar spine as the surgeon was concerned that she may have had a recurrent disc prolapse.
   

What can you see in this scan done seven months post spinal surgery?

• Is there a recurrent disc prolapse?
• Can you see any post operative relevant changes?
• Is there any other pathology?

Look at the MRI scan of the rest of the spine and brain – what can you see?

• What is the likely diagnosis?
• What is your next course of action?
• What other tests are likely to be done?