Clinical Cases

Clear sequestration while in flexion

For approximately one year, this 56-year-old female patient has experienced pain in the caudal lumbar region with a paravertebral radiation on both sides and laterally into the right lower extremity.

The pain slightly diminishes when bending forward but remains while sitting or standing.


A – C: Sagittal images in a sitting position: flexion, neutral, extension

D: Axial image in a sitting position: neutral upright


The Upright-MRI images in a natural weight-bearing state reveal a dorsal shift of L4 onto L5 without substantial reduction of the ventro-dorsal diameter of the spinal canal. Flexion and extension do not display significant changes of spondylolisthesis. Only in flexion, the functional images, besides displaying a herniated disc to the medio-lateral right, succeed in clearly identifying a sequester that can merely be sensed in neutral or extension positions. In addition, the segment shows subcortical degenerative changes classified as MODIC I as well as intervertebral disc protrusions in segments L2 to L4.

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