Clinical question: Low back pain. Signs and symptoms: Low back pain and spasms. Nonenhanced brain MRI:T12 -- L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.At L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Tiny annular fissure far laterally on the right (sagittals T2/T2 stir image 12).L2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum and moderate right facet hypertrophy changes. Constellation of changes result in mild central spinal and right neural foraminal compromise.L4 -- L5 demonstrate mild disk disease, mild (right greater than left) facet and ligamentum flavum hypertrophy is present. Although there is subtle flattening deformity of the thecal sac secondary to ligamentum flavum hypertrophy there is no central spinal stenosis in the AP axis. Mild compromise of the lateral recess of the canal bilaterally is noted.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate to significant asymmetric right-sided ligamentum flavum and facet hypertrophy changes are present. Constellation of changes results in mild right neural foraminal compromise and no central spinal stenosis. Examination at this level also demonstrates a tiny central annular fissure is appreciated on sagittal T2 stir series 50 on image 8.
1.Degenerative changes at the L3 -- L4 with resultant mild central spinal and right neural foraminal stenosis.2.Degenerative changes at the L4 -- L5 results in compromise of the lateral recesses bilaterally. Mild compromise of transverse axis of thecal sac however no spinal stenosis in AP axis.3.At L5 -- S1 asymmetric right-sided facet and ligamentum flavum hypertrophy results in mild right neural foraminal compromise.4.Tiny annular fissures in the midline at L5 -- S1 and far right at L1 -- L2 as detailed.