Clinical and Radiological Findings of Foraminal Disc Herniation

Bo-Hyeon Kim; Dong-Soo Kim; Yong-Min Kim; Hyun-Chul Shon; Kyoung-Jin Park; Jun-Mo Jeon

doi:10.4184/jkss.2005.12.2.106

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Kim, Kim, Kim, Shon, Park, and Jeon: Clinical and Radiological Findings of Foraminal Disc Herniation

Original Article

Journal of Korean Spine Surg 2005;12(2):106-114.

Published online: 12 February 2005

DOI: https://doi.org/10.4184/jkss.2005.12.2.106

Clinical and Radiological Findings of Foraminal Disc Herniation

Bo-Hyeon Kim, M.D.^#, Dong-Soo Kim, M.D., Yong-Min Kim, M.D., Hyun-Chul Shon, M.D., Kyoung-Jin Park, M.D., Jun-Mo Jeon, M.D.

Department of Orthopedic Surgery, Cheongju, Korea

^#Chungbuk National University Cheongju St. Mary's Hospital, Cheongju, Korea

Address reprint requests to Dong-Soo Kim, M.D. Department of Orthopaedic Surgery, Chungbuk National University Hospital, 62, Gaeshin-Dong, Cheong-Ju, Chungbuk, 360-711, Korea Tel: 82-43-269-6077, Fax: 82-43-274-8719, E-mail: kds@chungbuk.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study of clinical experiences.

Objectives

The correct discrimination of a compressed root is very important for proper decompression. With a foraminal disc herniation, the cephalad root is compressed. The diagnostic importance of the clinical and radiological findings was investigated.

Summary of literature Review

A compressed root, due to a herniated disc, is known as a caudal root (i. e. L5 root compressed by L4- 5 disc herniation). In some cases, a prolapsed disc may compress the cephalad root, resulting in a difficult diagnosis.

Material and Method

The medical records, plain X - ray and MRI of 17 patients were reviewed, and the physical examination and MRI findings were carefully evaluated to retrospectively document the efficacy of the diagnoses. Every MRI image of each patient was graded according to the 4 point ranking system of diagnostic efficacy devised by the authors. The clinical outcomes and postoperative complications were also investigated.

Results

Ten, 5 and 2 of the 17 patients had L4- 5, L5- S1 and L3- 4 foraminal disc herniations, respectively. Eight of 10 L4- 5 cases showed a positive femoral nerve stretching test. The knee jerk reflex was diminished in 7 patients, with bilateral hypore-flexia in the other 3. The bodycut axial MRI image was the most effective, and the coronal images were also very helpful, whereas the routine axial images were of least value. Most cases achieved a satisfactory clinical result.

Conclusions

Foraminal disc herniations seem to be reasonably common. For the accurate discrimination of a compressed root, a thorough physical examination seems to be very important. When MRI is performed for these cases, in addition to routine studies, the bodycut axial and coronal MRI images are effective and useful, and their use is strongly recommended.

Keywords: Foraminal disc herniation, Physical exam, MRI, Bodycut axial, Coronal

REFERENCES

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Fig. 1.

(A) Scout film of routine axial image (B) Scout film of bodycut axial image

Fig. 2.

A 59 year-old man with severe radiating pain on left lower extremity. (A) T2 sagittal image shows protrusion of L4-5 disc, which usually suggests compression of L5 root. (B) T2-coronal view shows upward migration of disc material from L4-5, compressing left L4 root (dark arrow). (C, D) T1 (C) and T2 (D) bodycut axial views showing compression of left L4 root by disc material (white arrows).

Table 1.

Authors’ Grading of Diagnostic Efficacy of Each MR Image

Grade	0	no abnormality
	1	abnormal, but problem unknown
	2	disc problem, compressed root unknown
	3	compressed root confirmed by this image

Table 2.

Physical examination and MRI gradings in L4-5 foraminal disc herniation

	시상면		축상면		관상면	척추체단면 축상면		R-SLR	K	Motor	Sensory
	T1	T2	T1	T2	T2	T1	T2
F/46	++	++	0	0	+++	+++	+++	+	0	Normal	Normal
M/44	+	0	+	+	+	+++	+++	+	0	⇓	⇓
M/59(I)	++	+++	+	0	+++	+++	+++	U	n.c	⇓	⇓
M/59(II)	++	++	+	+	+++	+++	+++	+	0	⇓	⇓
F/63	0	0	++	+	+++	-	-	+	0	Normal	Normal
M/72	++	+	0	+	++	-	-	++	0	Normal	Normal
F/64	++	+	0	0	-	-	-	U	n.c	⇓	Normal
M/35	+++	+++	++	++	+++	+++	+++	+	0	Normal	⇓
F/39	++	++	++	++	+++	+++	+++	+	0	⇓	⇓
M/67	+++	++	++	+	+++	-	-	+	n.c	Normal	Normal

0~+++: grade of diagnostic efficacy (page 4) U: uncheckable -: not done KJ: knee jerk 0: absent n.c: none contributary

Table 3.

Physical examination and MRI gradings in L5-S1 foraminal disc herniation

	시상면		축상면		관상면	척추체단면 축상면		Motor	Sensory
	T1	T2	T1	T2	T2	T1	T2
F/65	+++	+++	++	++	+++	+++	+++	Normal	⇓
M/58	++	+++	+	+	+++	-	-	⇓	Normal
F/67	++	++	0	0	++	-	-	Normal	Normal
F/56	+	0	++	0	-	-	-	⇓	⇓
M/50	++	+++	++	++	+++	-	-	⇓	Normal

Table 4.

Physical examination and MRI gradings in L3-4 foraminal disc herniation

	시상면		축상면		관상면	척추체단면 축상면		Motor	Sensory
	T1	T2	T1	T2	T2	T1	T2
F/48	+	0	+	0	++	+++	++	Normal	Normal
F/67	++	++	++	++	+++	-	-	-	-

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