Clinical question: Low back pain with left-sided radiation. Signs and symptoms: As above. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.Lower most visualized thoracic spine and thoracic cord are unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk desiccation and mild hypertrophy of ligamentum flavum and minute fluid signal intensity in the right facet space. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk desiccation and loss of disk height, moderate right and mild to moderate left facet and ligamentum flavum hypertrophy. There is a central and slightly to the right broad-based disk protrusion resulting in subtle flattening and posterior displacement of the cord and mild central spinal stenosis. Mild bilateral neural foraminal compromise secondary to degenerative changes is also present.L5 -- S1 demonstrate moderate disk disease and loss of disk height , moderate left and mild right facet and ligamentum flavum hypertrophy is also noted. There is no central scar stenosis however moderate left and mild right neural foraminal compromise is detected. Bilateral SI joints and perispinal soft tissue/musculature remains unremarkable.
1.Degenerative changes at L4 -- L5 and a central disk protrusion results in mild central spinal stenosis. Bilateral neural foraminal compromise as detailed.2.Moderate disk disease and loss of disk height without central spinal stenosis however with bilateral neural foraminal compromise at L5 -- S1 is noted.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise.