Clinical question: Bilateral hip pain going down to knees. Rule out spinal stenosis. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral, however lead exaggerated lumbar lordosis with resultant near horizontal positioning of the sacral spine. Lower most visualized thoracic spine and thoracic cord is unremarkable from T10 inferiorly. Examination at T12-L1 through L2-L3 levels demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease and mild ligamentum flavum and facet hypertrophy. There is mild mass effect on the thecal sac secondary to ligamentum flavum and mild central spinal stenosis without neural foraminal compromise..L4-L5 demonstrate mild disc disease and moderate ligamentum flavum and facet hypertrophic changes which includes minimal left facet effusiont. There is mild central spinal and bilateral lateral recess compromise and moderate mild bilateral neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and moderate bilateral (left greater than right) facet and ligamentum flavum hypertrophic changes. No evidence of central spinal stenosis however significant left and moderate to significant right neural foraminal compromise as well as lateral recess compromise bilaterally. There is evidence of left-sided facet effusion and minimally on the right.
1.Examination is unremarkable from T11-T12 through L2-L3 levels without spinal stenosis or neural foramina compromise.2.Degenerative changes at L3-L4 results in mild central spinal stenosis.3.L4-L5 degenerative changes results in mild central spinal stenosis and bilateral neural foraminal and lateral recess compromise.4.L5-S1 demonstrate mild degenerative disc disease and significant hypertrophic changes of posterior elements with resultant significant bilateral (left >t right) neural foraminal compromise as well as lateral recess compromise bilaterally however without central spinal stenosis.5.There is normal anatomical alignment of vertebral column however exaggeration of lower lumbar lordosis results in near horizontal projection of sacral spine in relation to lumbar spine.