PMC8168690_01
Mid-sagittal T2-weighted magnetic resonance imaging (MRI) 15 years before admission showed an L5/S1 disc herniation (on of the Yellow Ligament. or longitudinal (a). Mid-sagittal and axial T2-weighted MRI 10 months before admission demonstrated cauda equina compression at L4/5 caused by a hypointense anterior central disc herniation ( ) and a posterior isointense lesion ( ) (b and c).
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F1
Fifteen years ago, this now 40-year-old female had undergone a L5S1 discectomy [Figure 1a]. Ten months before this admission, due to complaints of low back pain and left leg numbness, she had undergone a lumbar; MR; it documented significant cauda equina compression at the L4-L5 level due to a large central disc herniation and marked stenosis/OYL (i.e., isointense on T2-weighted sequences) [Figures 1b and c].
Mid-sagittal and axial T2-weighted magnetic resonance imaging after hospital admission demonstrated cauda equina compression caused by progression of the L4/5 disc herniation ( ) (a and b). Mid-sagittal and axial computed tomography (CT) revealed ossification of the yellow ligament at the L4/5 level ( ) (c and d).
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F2
Postoperative mid-sagittal and axial T2-weighted magnetic resonance imaging confirmed cauda equina decompression (a and b). Mid-sagittal and axial computed tomography confirmed complete removal of the ossified yellow ligament (c and d).
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F3
OYL, and a partial central discectomy (i.e., not completely removed because of its central location), the patient never fully recovered; she had just 1/5 motor function bilaterally (i.e., residual loss perineal sensation and urinary incontinence - final JOA score 9/29) 1 month later. Of interest, the postoperative MR and CT studies, despite showing mild residual ventral disc, confirmed adequate cauda equina decompression [Figures 3a-d].