Clinical question: Evaluate for herniated disc or spinal stenosis. Signs and symptoms: Worsening sciatica. Nonenhanced lumbar MRI:Examination demonstrates moderate to advanced degenerative disc disease of the lumbar spine with resultant mild reversal of lumbar lordosis.The signal intensity of vertebral column demonstrate changes secondary to degenerative disease and unremarkable otherwise.The alignment of vertebral column remains anatomical.Limited view of the lower thoracic spine demonstrate moderate left neural foraminal compromise due to DJD at T11-T12 and no central spinal stenosis.T12-L1 is unremarkable.L1-L2 demonstrate moderate disc disease and loss of disc height, asymmetric (left greater than right) bulging disc with resultant subtle mass effect on the thecal sac is noted. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate advanced disc disease with significant loss of disc height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes are present. Shallow broad-based bulging disc is also noted. There is resultant mild central spinal stenosis and moderate right neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, diffuse bulging disc more prominent on the right is noted. There is also moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes present. Mild central spinal stenosis and significant right and moderate left neural foraminal compromise is noted.L4-L5 demonstrate advanced disc disease and loss of disc height, broad-based bulging disc more prominent on the left, moderate bilateral ligamentum flavum and moderate left facet and mild right facet hypertrophy changes are present. There is no convincing evidence of central spinal stenosis however significant left neural foraminal and left lateral recess compromise is noted.L5-S1 demonstrate mild disc disease and moderate bilateral ligamentum flavum and mild facet hypertrophic changes without central spinal stenosis. Mild bilateral neural foraminal compromise is however present.
1.Extensive degenerative changes of lumbar spine with a slightly alternative pattern of degree of degenerative changes likely secondary to mild scoliosis as detailed.2.There is mild central spinal stenosis at L2-L3 and L3-L4 levels as detailed.3.There are multilevel neural foraminal and lateral recess compromise (some significantly) as detailed per level above.4.Lower most visualized thoracic spine demonstrate asymmetric left-sided facet hypertrophic changes with resultant significant left neural foraminal compromise at T11-T12 level and no central spinal stenosis.