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An uncommon cause of lumbar radiculopathy
  1. M Belthur,
  2. R Thonse
  1. Department of Orthopaedics, Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2XP, UK

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    A 65 year old woman presented with a history of low back pain of 18 months' duration. There was radiation down the right lower limb posteriorly down to the ankle and the dorsum of the foot for the previous six months. Pain was aggravated by sitting and activity. Back to leg pain ratio was 40:60. There was no history of claudication pain. She did not have symptoms of weakness of legs or of bowel/bladder involvement.

    She had a positive straight leg raise test on right of 50 degrees with positive sciatic stretch test. There was reduced sensation in right L5 nerve root distribution. No motor or sphincter involvement was present. The rest of the spinal examination was normal. Radiography revealed degenerative changes in the lower lumbar spine. Magnetic resonance imaging (MRI) scans (sagittal and axial views) of the patient are shown in figs 1 and 2.

    Figure 1

    Sagittal T2-weighted MRI scan of the lumbosacral spine.

    Figure 2

    Axial T2-weighted MRI scan of the lumbar spine at L4/5 level.

    QUESTIONS

    1. What are the features seen on the MRI scan?

    2. What is the likely diagnosis?

    3. What is the usual line of management?

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