Ruptured S1-S2 disc presenting with S2 radiculopathy

Area of Science:

• Neurology
• Neurosurgery
• Spinal Cord Medicine

Background:

• Spinal disc herniation typically affects lumbar or cervical regions.
• Sacral disc herniation is rare, with limited documented cases.
• Understanding sacral disc pathologies is crucial for diagnosing and treating rare neurological deficits.

Observation:

• A 61-year-old male presented with new-onset numbness affecting the right penis, scrotum, and perineum.
• The onset of symptoms coincided with a forceful physical activity (jumping into a swimming pool).
• Neurological examination and imaging revealed a lesion at the S1-S2 level compressing the right S2 nerve root.

Findings:

• Magnetic resonance imaging (MRI) and computed tomographic (CT) scans identified a lesion impinging on the S2 nerve root.
• Surgical exploration revealed extruded disc material originating from an atypical location.
• Histopathological analysis confirmed the presence of ruptured disc material.
• Post-operative resolution of the sensory deficit in the perineal region was observed.

Implications:

• This case highlights a rare instance of sacral disc herniation causing specific neurological symptoms.
• The findings suggest that forceful activities can precipitate sacral disc rupture in susceptible individuals.
• Laminectomy and surgical excision of the extruded disc material proved effective, supporting this as a viable treatment modality.
• Further research into the biomechanics and etiology of sacral disc herniation is warranted.