Clinical question: Pain in right hip and down the back of right thigh. Signs and symptoms: Sciatica. Nonenhanced lumbar MRI: The lower most visualized thoracic spine and thoracic cord is unremarkable from T10 inferiorly.T12-L1 demonstrate a right para median disc protrusion minimal mass effect on the thecal sac without spinal stenosis or neural foraminal compromise. Findings demonstrate interval decreased size since prior study.L1-L2 demonstrate minimal degenerative changes and unremarkable otherwise.L2-L3 demonstrate advanced disc disease with significant loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is broad-based bulging disc however with interval decreased size of a right para median disc region with inferior migration since prior study. There is residual extruded disc posterior to the vertebral body of L3 on the right and with resultant right lateral recess compromise however without evidence of spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate to advanced disc disease, new mild grade 1 anterolisthesis without central spinal stenosis however significant right neural foraminal compromise with interval worsening is detected.L4-L5 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy however without spinal stenosis. No significant neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height of mild facet and ligamentum flavum degenerative disease and hypertrophy. No spinal stenosis however moderate right neural foraminal compromise detected.
1.At L2-L3 there is evidence of interval decreased size of a right lateral disc extrusion inferior migration posterior to L3 level. No central spinal stenosis however right lateral recess compromise is detected.2.L3-L4 demonstrate progression of degenerative disease with resultant new mild grade 1 anterolisthesis and new significant right neural foraminal compromise.3.Interval decreased size of a right para median disc protrusion at T12-L1 however without spinal stenosis or neural foraminal compromise.