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Extraforaminal with or without foraminal disk herniation: reliable MRI findings
In Sook Lee1, Hak Jin Kim, Jung Sub Lee
1Department of Radiology, School of Medicine, Pusan National University, Medical Research Institute, 1-10 Ami-Dong, Seo-Gu, Busan, Republic of Korea.
Objective:
The purpose of our study was to evaluate spinal MR images for extraforaminal disk herniation with or without foraminal disk herniation to determine the reliable MRI findings.
Materials And Methods:
Thirty-five patients with extraforaminal with or without foraminal disk herniation confirmed at radiculography or surgery between March 2005 and July 2007 underwent spinal MRI. We assessed the morphologic features of the disk, changes in nerve root thickness, epidural fat obliteration surrounding the nerve root, and displacement of the nerve root in the foraminal and extraforaminal zones.
Results:
Mixed disk herniation was found in 23 patients, and purely extraforaminal herniation was found in 12 patients. Focal eccentricity of the disk contour was identified in 32 patients (91%). Change in the nerve root thickness was found in 30 patients (86%). The nerve roots were displaced in 22 patients (63%), and the original location was maintained in nine patients (26%). Differentiation between the disk and the nerve root was poor in four of the 35 patients (11%). Obliteration of the epidural fat surrounding the nerve root was present in all patients.
Conclusion:
The presence of extraforaminal with or without foraminal disk herniation should be ascertained on the basis of the following MRI findings: focal eccentricity of the disk contour, obliteration of epidural fat surrounding the nerve root, change in the thickness of the nerve root, and displacement of the nerve root.
Insights
Spinal MRI reliably detects extraforaminal disk herniation using focal disk contour changes, nerve root displacement, and epidural fat obliteration. These findings aid in diagnosing herniations with or without foraminal involvement.
Area of Science:
- Radiology
- Neurosurgery
- Orthopedics
Background:
- Extraforaminal disk herniation can be challenging to diagnose.
- Accurate identification is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate spinal magnetic resonance imaging (MRI) findings for diagnosing extraforaminal disk herniation, with or without concurrent foraminal disk herniation.
- To identify reliable MRI indicators for this condition.
Main Methods:
- Retrospective analysis of spinal MRI scans from 35 patients with confirmed extraforaminal or combined foraminal/extraforaminal disk herniation.
- Assessment of disk morphology, nerve root thickness changes, epidural fat obliteration, and nerve root displacement.
Main Results:
- Focal disk contour eccentricity was observed in 91% of patients.
- Nerve root thickness changes were present in 86%, and displacement in 63%.
- Obliteration of epidural fat surrounding the nerve root was a universal finding (100%).
Conclusions:
- Spinal MRI can reliably ascertain extraforaminal disk herniation.
- Key diagnostic MRI findings include focal disk contour eccentricity, epidural fat obliteration, nerve root thickness changes, and nerve root displacement.
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