Clinical question: Backache, numbness in right leg and left shoulder pain. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.Normal stimuli thoracic spine and thoracic cord is unremarkable. T11 -- T12 is unremarkable.T12 -- T11 demonstrate mild disk disease and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate right neural foraminal compromise is noted.L4 -- 5 demonstrate advanced disk disease with significant loss of disk height, moderate to significant left and moderate right facet and ligamentum flavum hypertrophy is present. Constellation of changes results in mild central spinal stenosis and moderate bilateral (left greater than right) neural foraminal compromise.L5 -- S1 demonstrate mild degenerative changes and unremarkable otherwise.
1.Degenerative changes of disk and the posterior elements at L4 -- L5 with mild central spinal stenosis and moderate (L>R) neural foraminal compromise as detailed.2.Degenerative changes at the L3 -- L4 results in moderate right neural foraminal compromise.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise.