Differential Diagnosis

• Single most likely diagnosis
  • Herniated nucleus pulposus: The description of a central protrusion/annular fissuring measuring 6 mm and abutting the ventral thecal sac is most consistent with a herniated disc, which is a common cause of back pain and radiculopathy.
• Other Likely diagnoses
  • Degenerative disc disease: The presence of mild right predominant uncovertebral and bilateral facet hypertrophy, along with the herniated disc, suggests degenerative changes in the spine.
  • Annular tear: The mention of annular fissuring could also indicate an annular tear, which can be a source of pain and can sometimes be associated with disc herniation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Spinal tumor (e.g., schwannoma, meningioma): Although less likely, a spinal tumor could present with similar imaging findings and would have significant implications for treatment and prognosis.
  • Infection (e.g., discitis, osteomyelitis): Infection in the spine can cause destruction of the disc and adjacent bone, potentially mimicking some of the findings described.
  • Cauda equina syndrome: While the patent spinal canal and neural foramen make this less likely, any condition causing significant compression or disruption of the cauda equina can lead to serious neurological deficits.
• Rare diagnoses
  • Intradural disc herniation: A rare condition where the herniated disc material penetrates through the dura mater, potentially causing more severe neurological symptoms.
  • Spinal synovial cyst: A cyst that forms from the facet joint and can compress the spinal cord or nerve roots, though this would more likely be associated with facet hypertrophy and less with central disc protrusion.