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Testicular ptosis as a sign of L2 radiculopathy.

A 71-year-old man was referred to the Mayo Comprehensive Spine Center for possible surgery on a left L2–3 disk extrusion. Superimposed on a past history of episodic low back pain, 6 months prior, the patient developed major low back and left flank pain after moving some rocks. Over the course of a few days, the pain became so severe that he visited his local emergency department and received temporary benefit from an injection of morphine and a brief course of oral prednisone. He continued to have severe pain in his lower back and left flank and developed pain in his left anterior iliac crest and proximal left medial, anterior, and lateral thigh, with numbness, sensitivity, and brief neuralgic pains over his left anterolateral thigh. His lower limb reflexes were reportedly normal. Within a month of symptom onset, he underwent lumbar spine MRI and subsequent CT myelography, both of which showed a left L2–3 disk extrusion with superior migration and L2 nerve root impingement (see figure 1). An EMG was reported to show a left upper lumbar radiculopathy. He had a left L2–3 transforaminal epidural steroid injection that helped him briefly. He did not notice any weakness or bowel or bladder difficulty. He had noted that ever since his pain began, his left testis was hanging considerably lower than the right. He estimated that the left testicle had hung 6 cm lower than the right at its nadir. His pain and testicular ptosis had improved over time, albeit incompletely, when we saw him. He was otherwise in good health except for a history of right rotator cuff disease, and he was taking only ibuprofen for pain.