Nerve root compression by herniated intradiscal gas

Case report

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✓ Intervertebral disc degeneration of any etiology may be associated with the formation of spaces or clefts within the disc. Gas collects within these spaces and can be seen roentgenographically. A case is presented in which intradiscal gas herniated into a connective tissue capsule, displacing the left S-1 nerve root and producing symptoms and signs identical to those of a herniated nucleus pulposus. The pathophysiology of gas within a disc space and the possibility that it may herniate much like the nucleus pulposus is discussed.

Article Information

Address reprint requests to: James T. Robertson, M.D., Department of Neurosurgery, University of Tennessee College of Medicine, 956 Court Avenue, Memphis, Tennessee 38163.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Lumbar myelogram showing amputation of the left S-1 nerve root sleeve and indentation of the thecal sac at the L5–S1 level (arrow). Right: Postmyelography computerized tomography scan at the L5–S1 level showing an epidural collection of gas (arrow) compressing the left S-1 nerve root and thecal sac.

References

  • 1.

    Austin RMBankoff MSCarter BL: Gas collections in the spinal canal on computed tomography. J Comput Assist Tomogr 5:5225241981Austin RM Bankoff MS Carter BL: Gas collections in the spinal canal on computed tomography. J Comput Assist Tomogr 5:522–524 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Beers GJCarter APLeiter Bet al: CT detection of retroperitoneal gas associated with gas in intervertebral disks. J Comput Assist Tomogr 8:2322361984Beers GJ Carter AP Leiter B et al: CT detection of retroperitoneal gas associated with gas in intervertebral disks. J Comput Assist Tomogr 8:232–236 1984

    • Search Google Scholar
    • Export Citation
  • 3.

    Bielecki DKSartoris DResnick Det al: Intraosseous and intradiscal gas in association with spinal infection: report of three cases. AJR 147:83861986Bielecki DK Sartoris D Resnick D et al: Intraosseous and intradiscal gas in association with spinal infection: report of three cases. AJR 147:83–86 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Boikess RSEdelson E: Chemical Principlesed 3. New York: Harper & Row1985 pp 112113Boikess RS Edelson E: Chemical Principles ed 3. New York: Harper & Row 1985 pp 112–113

    • Search Google Scholar
    • Export Citation
  • 5.

    Boikess RSEdelson E: Chemical Principlesed 3. New York: Harper & Row1985 p 455Boikess RS Edelson E: Chemical Principles ed 3. New York: Harper & Row 1985 p 455

    • Search Google Scholar
    • Export Citation
  • 6.

    Deeb ZFrayha RA: Multiple vacuum discs, an early sign of ochronosis. Radiologic findings in two brothers. J Rheumatol 3:82871976Deeb Z Frayha RA: Multiple vacuum discs an early sign of ochronosis. Radiologic findings in two brothers. J Rheumatol 3:82–87 1976

    • Search Google Scholar
    • Export Citation
  • 7.

    Demierre BRamadan AHauser Het al: Radicular compression due to lumbar intraspinal gas pseudocyst: case report. Neurosurgery 22:7317331988Demierre B Ramadan A Hauser H et al: Radicular compression due to lumbar intraspinal gas pseudocyst: case report. Neurosurgery 22:731–733 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Elster ADJensen KM: Vacuum phenomenon within the cervical spinal canal: CT demonstration of a herniated disc. J Comput Assist Tomogr 8:5335351984Elster AD Jensen KM: Vacuum phenomenon within the cervical spinal canal: CT demonstration of a herniated disc. J Comput Assist Tomogr 8:533–535 1984

    • Search Google Scholar
    • Export Citation
  • 9.

    Fick R: Handbuch der Anatomie und Mechanik der Gelenke. II. Jena: G Fischer1910Fick R: Handbuch der Anatomie und Mechanik der Gelenke. II. Jena: G Fischer 1910

    • Search Google Scholar
    • Export Citation
  • 10.

    Ford LTGilula LAMurphy WAet al: Analysis of gas in vacuum lumbar disc. AJR 128:105610571977Ford LT Gilula LA Murphy WA et al: Analysis of gas in vacuum lumbar disc. AJR 128:1056–1057 1977

    • Search Google Scholar
    • Export Citation
  • 11.

    Ford LTGoodman FG: X-ray studies of the lumbosacral spine. South Med J 59:112311281966Ford LT Goodman FG: X-ray studies of the lumbosacral spine. South Med J 59:1123–1128 1966

    • Search Google Scholar
    • Export Citation
  • 12.

    Fuiks DMGrayson CE: Vacuum pneumarthrography and the spontaneous occurrence of gas in the joint spaces. J Bone Joint Surg (Am) 32:9339381950Fuiks DM Grayson CE: Vacuum pneumarthrography and the spontaneous occurrence of gas in the joint spaces. J Bone Joint Surg (Am) 32:933–938 1950

    • Search Google Scholar
    • Export Citation
  • 13.

    Ganong WF: Review of Medical Physiologyed 13. Los Altos, Calif: Appleton & Lang1987 p 547Ganong WF: Review of Medical Physiology ed 13. Los Altos Calif: Appleton & Lang 1987 p 547

    • Search Google Scholar
    • Export Citation
  • 14.

    Gentry LRTurski PAStrother CMet al: Chymopapain chemonucleolysis: CT changes after treatment. AJR 145:3613691985Gentry LR Turski PA Strother CM et al: Chymopapain chemonucleolysis: CT changes after treatment.AJR 145:361–369 1985

    • Search Google Scholar
    • Export Citation
  • 15.

    Gershon-Cohen J: The phantom nucleus pulposus. AJR 56:43481946Gershon-Cohen J: The phantom nucleus pulposus. AJR 56:43–48 1946

  • 16.

    Gershon-Cohen JSchraer HSklaroff DMet al: Dissolution of the intervertebral disk in the aged normal. The phantom nucleus pulposus. Radiology 62:3833871954Gershon-Cohen J Schraer H Sklaroff DM et al: Dissolution of the intervertebral disk in the aged normal. The phantom nucleus pulposus. Radiology 62:383–387 1954

    • Search Google Scholar
    • Export Citation
  • 17.

    Gulati ANWeinstein ZR: Gas in the spinal canal in association with the lumbosacral vacuum phenomenon. CT findings. Neuroradiology 20:1911921980Gulati AN Weinstein ZR: Gas in the spinal canal in association with the lumbosacral vacuum phenomenon. CT findings. Neuroradiology 20:191–192 1980

    • Search Google Scholar
    • Export Citation
  • 18.

    Kaiser MCCapesius PVeiga-Pires JAet al: Recognition of gas-containing disc herniation on lateral CT-scoutview. Neuroradiology 29:981987 (Case note)Kaiser MC Capesius P Veiga-Pires JA et al: Recognition of gas-containing disc herniation on lateral CT-scoutview. Neuroradiology 29:98 1987 (Case note)

    • Search Google Scholar
    • Export Citation
  • 19.

    Knutsson F: The vacuum phenomenon in the intervertebral discs. Acta Radiol 23:1731791942Knutsson F: The vacuum phenomenon in the intervertebral discs. Acta Radiol 23:173–179 1942

    • Search Google Scholar
    • Export Citation
  • 20.

    Kumar RWest CGHGillespie JE: Gas in a spinal extradural cyst. Case report. J Neurosurg 70:4864881989Kumar R West CGH Gillespie JE: Gas in a spinal extradural cyst. Case report. J Neurosurg 70:486–488 1989

    • Search Google Scholar
    • Export Citation
  • 21.

    Lardé DMathieu DFrija Jet al: Spinal vacuum phenomenon: CT diagnosis and significance. J Comput Assist Tomogr 6:6716761982Lardé D Mathieu D Frija J et al: Spinal vacuum phenomenon: CT diagnosis and significance. J Comput Assist Tomogr 6:671–676 1982

    • Search Google Scholar
    • Export Citation
  • 22.

    Magnusson W: Über die bedingungen des Hervortretens der wirklichen Gelenkspalte auf dem röntgenbilde. Acta Radiol 18:7337411937Magnusson W: Über die bedingungen des Hervortretens der wirklichen Gelenkspalte auf dem röntgenbilde. Acta Radiol 18:733–741 1937

    • Search Google Scholar
    • Export Citation
  • 23.

    Marr JT: Gas in intervertebral discs. AJR 70:8048091953Marr JT: Gas in intervertebral discs. AJR 70:804–809 1953

  • 24.

    Orrison WWLilleas FG: CT demonstration of gas in a herniated nucleus pulposus. J Comput Assist Tomogr 6:8078081982Orrison WW Lilleas FG: CT demonstration of gas in a herniated nucleus pulposus. J Comput Assist Tomogr 6:807–808 1982

    • Search Google Scholar
    • Export Citation
  • 25.

    Pate DKatz A: Clostridia discitis. A case report. Arthritis Rheum 22:103910401979Pate D Katz A: Clostridia discitis. A case report. Arthritis Rheum 22:1039–1040 1979

    • Search Google Scholar
    • Export Citation
  • 26.

    Raines JR: Intervertebral disc fissures (vacuum intervertebral disc). AJR 70:9649661953Raines JR: Intervertebral disc fissures (vacuum intervertebral disc). AJR 70:964–966 1953

    • Search Google Scholar
    • Export Citation
  • 27.

    Resnick DNiwayama GGoergen TGet al: Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD). Pseudogout. Radiology 122:1151977Resnick D Niwayama G Goergen TG et al: Clinical radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD). Pseudogout. Radiology 122:1–15 1977

    • Search Google Scholar
    • Export Citation
  • 28.

    Resnick DNiwayama GGuera Jet al: Spinal vacuum phenomena. Anatomical study and review. Radiology 139:3413481981Resnick D Niwayama G Guera J et al: Spinal vacuum phenomena. Anatomical study and review. Radiology 139:341–348 1981

    • Search Google Scholar
    • Export Citation
  • 29.

    Reymond RDWheeler PSPerovic Met al: The lucent cleft, a new radiographic sign of cervical disc injury or disease. Clin Radiol 23:1881921972Reymond RD Wheeler PS Perovic M et al: The lucent cleft a new radiographic sign of cervical disc injury or disease. Clin Radiol 23:188–192 1972

    • Search Google Scholar
    • Export Citation
  • 30.

    Ritchie JHFahrni WH: Age changes in lumbar intervertebral discs. Can J Surg 13:65711970Ritchie JH Fahrni WH: Age changes in lumbar intervertebral discs. Can J Surg 13:65–71 1970

    • Search Google Scholar
    • Export Citation
  • 31.

    Schabel SIMoore TERittenberg GMet al: Vertebral vacuum phenomenon. A radiographic manifestation of metastatic malignancy. Skeletal Radiol 4:1541561979Schabel SI Moore TE Rittenberg GM et al: Vertebral vacuum phenomenon. A radiographic manifestation of metastatic malignancy. Skeletal Radiol 4:154–156 1979

    • Search Google Scholar
    • Export Citation
  • 32.

    Tash RRWeitzner I Jr: Acute intervertebral gas following vertebral fracture. CT demonstration. J Comput Assist Tomogr 10:7077081986Tash RR Weitzner I Jr: Acute intervertebral gas following vertebral fracture. CT demonstration. J Comput Assist Tomogr 10:707–708 1986

    • Search Google Scholar
    • Export Citation

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