Clinical question: Low back pain. Signs and symptoms: Low back pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate advanced disc disease and loss of disc height, mild hypertrophic changes of posterior elements and result in mild central spinal stenosis and mild bilateral neural foraminal compromise.C4-C5 demonstrate advanced disc disease and loss of disc height, evidence of prior bilateral laminectomy and without evidence of central spinal stenosis. Mild bilateral neural foraminal compromise is noted.C5-C6 demonstrate moderate disc disease and loss of disc height, evidence of prior posterior bilateral laminectomy with expansion of thecal sac and no residual central spinal stenosis. Mild bilateral neural foraminal compromise.C6-C7 demonstrate moderate disc disease and loss of disc height, mild hypertrophic changes of posterior elements with resultant mild to moderate central spinal stenosis and no definitive neural foraminal compromise.C7-T1 demonstrate moderate disc disease and loss of disc height, shallow broad-based bulging disc, flattening and posterior displacement of the cord and moderate central spinal stenosis and moderate left neural foraminal compromise.Upper most visualized thoracic spine to T4 level demonstrate uniformly smaller than expected caliber of the spinal canal likely representing a congenital anatomical variation.The signal intensity of cervical and upper most visualized thoracic cord remains within normal.Nonenhanced lumbar MRI:T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild disc desiccation, mild bilateral ligamentum flavum hypertrophy and bilateral facet effusion. No spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc desiccation and loss of disc height, there is a central broad-based disc protrusion with subtle mass effect on the thecal sac however without convincing evidence of central spinal stenosis.Mild to moderate left neural foraminal compromise and mild left lateral recess compromise is present.L5-S1 is unremarkable.The lower most visualized thoracic cord, conus and the cauda equina is unremarkable.
1.Examination of the cervical spine is a status post multilevel laminectomy and posterior fusions including placement of transpedicular screws. No central spinal stenosis at the level of surgery. Mild Central spinal stenosis at C2-C3 level secondary to degenerative disease. Mild to moderate central spinal stenosis at C6/C7 and slightly more prominent at C7-T1 levels as detailed. There are multilevel mild neural foraminal compromise as detailed per level above. The signal intensity and caliber of cervical cord remains within normal.2.Examination of lumbar spine demonstrate a broad-based central disc protrusion at L4-L5 without definitive spinal stenosis however mild to moderate left neural foraminal and mild left lateral recess compromise is present. Mild degenerative changes at other levels without central spinal stenosis or neural foraminal compromise. Bilateral facet effusions at L3-L4 and L4-L5 levels are noted.