Clinical question: History of L4-L5 discectomy with recurrent back and right leg pain. Evaluate for herniation. Signs and symptoms: Right leg pain, back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is unremarkable signal intensity of the vertebral column.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild facet disease without significant degenerative disc disease. No neural foraminal compromise however mild central spinal stenosis is suspected. This finding demonstrate no significant change since prior exam.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral (L> R) facet hypertrophic changes are noted. There is a large right lateral broad-based disc protrusion with resultant mass effect on the thecal sac, moderate central spinal stenosis and significant right lateral recess compromise. There is interval progression of findings since prior study. There is mild compromise of right neural foramina also secondary to hypertrophic changes. There is evidence of a small right sided surgical laminotomy at this level.L5-S1 is unremarkable.Unremarkable. Spinal soft tissues.
1.At L4-L5 there is a right lateral disc protrusion with resultant moderate central spinal stenosis and significant right lateral recess compromise. There is interval progression of findings since prior MRI exam from an outside institution.2.At L4-L5 mild degenerative changes results in mild central spinal stenosis similar to prior.3.Unremarkable images at other levels. Please review detailed report per level above.