Test Your X-Ray IQ: Low Back Pain With Leg Pain

This patient has low back pain with persistent leg pain. What’s wrong?

Noted here is an abnormal L5/S1 nerve root on the left.  The blue arrows represent a normal sized nerve root.  The red dashes are the L5/S1 nerve root on the left which is obviously enlarged. It takes up most of the space. On the image on the right, is what it looks like on the axial.  The left nerve root is basically being squeezed through the lateral recess.

Another great reason to use the localizer/scout line tool so you can triangulate findings and figure out if they are consistent and on what side.
When it comes to ddxs for this…the best two are going to be inflamed nerve or peripheral nerve sheath tumor.  A repeat MRI with contrast is needed to help further characterize the finding.

Plain film radiography can still be a helpful tool in evaluating for suspected soft tissue injuries (such as ACL tears) if you know what you’re looking for. Of course MRI is a much better modality, but x-ray can help guide you with your clinical evaluation.

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