Clinical question: 70 year-old female with history of lumbosacral radicular pain. Signs and symptoms: Low-back pain radiating down to the left foot. Nonenhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate left and mild right ligamentum flavum hypertrophy and minimal facet disease. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild to moderate disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy, mild bilateral widening of facet spaces with fluid signal intensity without significant hypertrophic changes and mild grade 1 anterolisthesis. Constellation of findings results in central spinal stenosis and lateral recess compromise bilaterally (left greater than right). No neural foraminal compromise. Examination also demonstrates a tiny synovial cyst on the left at this level (axial T2 series 7 image 19) projecting anterior to the left articulating facet and abutting the left ligamentum flavum. Tiny additional synovial cysts are also noted posterior to the dictating facets at this level (left greater than right).L5 -- S1 demonstrate mild degenerative disk disease, mild bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.Unremarkable paraspinal soft tissues.
1.Degenerative changes at L4 -- L5 and including mild grade 1 anterolisthesis results in central spinal stenosis and lateral recess compromise bilaterally (left greater than right). Bilateral facet effusion and multiple small synovial cysts as detailed above.2.Unremarkable nonenhanced MRI of the lumber spine otherwise.