Clinical question: Patient with new onset numbness and pain shooting down left leg. Signs and symptoms: Sharp shooting pain left leg, and hip, also numbness Pre and post enhanced lumbar MRI:There is normal signal intensity and anatomical alignment of vertebral column.Unremarkable lower most visualized thoracic spine and thoracic cord.T12-L1, L1-L2, L2-L3 levels are unremarkable exception of mild hypertrophic changes of posterior elements.L3-L4 demonstrate mild disc desiccation, moderate bilateral ligamentum flavum hypertrophy and mild facet disease without spinal canal or neural foraminal compromise.L4-L5 demonstrates mild disc desiccation, mild bilateral ligamentum flavum hypertrophy and mild bilateral facet disease. There is a linear T2/T2 STIR hyperintensity within the annulus of the disc in the midline consistent with an annular fissure. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate a large central and rightward broad base disc protrusion with resultant significant right lateral recess compression and mass effect on the right S1 nerve root. There is moderate right neural foraminal compromise secondary to degenerative disease and partial extension of the protruded disc. No spinal stenosis and patent left neural foramina.Unremarkable post enhanced images.Unremarkable partially visualized SI joints.Unremarkable paraspinal soft tissues.
1.Central and rightward broad-based disc protrusion at L5-S1 with resultant significant mass effect on the right lateral recess and right S1 nerve root and the moderate compromise of right neural foramina. No spinal stenosis.2.With the exception of mild degenerative changes examination is unremarkable all other levels. A midline annular fissure at L4-L5 is noted as detailed above.