A large extruded L5-S1 disc causing progressive compression and neurological deficits(CES) with slow recovery after surgery

Abstract

A 40-year-old male presented with progressive paresthesia and weakness of the lower limbs and sphincter dysfunction. He had a history of low back pain and disk herniation from five years ago. Magnetic resonance imaging (MRI) revealed a very large mass-like lesion at L5-S1 segments, and computed tomography (CT) showed destruction of L5 lamina. While the main diagnosis was a large extruded disc, the possibility of extradural masses such as chordoma was also considered. The patient was immediately started on corticosteroid therapy and underwent laminectomy and discectomy surgery to remove the large free fragment compressing the neural elements. The patient reported feeling improvement in his feet and perineum one day after surgery, but follow-up examinations one and three months after surgery described incomplete recovery in sphincter function. This case highlights the importance of considering other possible diagnoses based on physical examination and imaging findings, even when the initial diagnosis seems clear, and emphasizes the need for timely intervention in cases of spinal cord compression to prevent permanent damage to the neural elements.