*CSF (cerebrospinal fluid).
In the MRI, a conspicuously herniated disk at the level of L3-L4 protrudes posteriorly (transligamentous herniation). The dural sac is deeply indented at that level.
As the stress resistance of the anulus fibrosus declines with age, the tissue of the nucleus pulposus may protrude through weak spots under loading. If the fibrous ring of the anulus ruptures completely, the herniated material may compress the contents of the intervertebral foramen (nerve roots and blood vessels). These patients often suffer from severe local back pain. Pain is also felt in the associated dermatome. When the motor part of the spinal nerve is affected, the muscles served by that spinal nerve will show weakening. It is an important diagnostic step to test the muscles innervated by a nerve from a certain spinal segment, as well as the sensitivity in the specific dermatome. Example: The first sacral nerve root innervates the gastrocnemius and soleus muscles; thus, standing or walking on toes can be affected.