Clinical question: Worsening back pain after an epidural. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column. There is unremarkable signal intensity of vertebral column are changes secondary to degenerative disease.As was noted on prior exam there is significant generalized narrowing of the spinal canal to represent a congenital anatomical variation.This finding in combination with degenerative disease resulting in multilevel central spinal stenosis without significant change since prior study.Previously noted a small epidural collection along the dorsal aspect of T12 as completely resolve and non-detectable on current exam.T12 -- L1 however demonstrate mild degenerative disease and bulging disk and resultant moderate central spinal stenosis without interval change and neural foraminal compromise.L1 -- L2 demonstrate mild disk disease, loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Similar to prior study there is evidence of mild to moderate central spinal stenosis and without neural foraminal compromise.L2 -- L3 demonstrate minimal disk desiccation without loss of disk height and a mild to moderate bilateral facet and ligamentum flavum hypertrophy. Mild central spinal stenosis and no neural foraminal compromise without change since prior exam.L3 -- 4 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. Constellation of degenerative changes in combination with congenitally small canal results in moderate to severe central spinal stenosis at this level and without evidence of neural foraminal compromise. There is no significant change since prior exam.L4 -- L5 demonstrate mild disk desiccation and moderate bilateral ligamentum flavum hypertrophy and to a lesser degree of facet hypertrophy. Changes of this level results in central spinal stenosis without change since prior exam. No convincing evidence of neural foraminal compromise. New since prior exam at this level is a small annular fissure in the left paramedian location (sagittal T2/T2 stir image 6).L5 -- S1 demonstrate mild disk desiccation and facet/ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.
1.Interval complete resolution of previously noted small epidural lesion likely sequestered disk along the dorsal aspect of T12 vertebral body.2.Interval tiny annular fissure at the L4 -- L5 since prior exam.3.Stable mild degenerative disk disease and moderate facet and ligamentum flavum hypertrophic changes are lumbar spine which in combination with congenitally small canal results in multilevel mild to moderate central spinal stenosis as detailed level.4.There is no appreciable neural foraminal compromise at any level.