Diagnosis: Other intervertebral disc degeneration, lumbosacral regionClinical question: Patient with chronic but advancing degree of lower back pain, evaluate for disk herniationSigns and Symptoms: Patient with advancing lumbar pain and LRE radicular pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. Patient motion partially obscures visualization of the spinal canal.At L5-S1 there is loss of disc space height, disc desiccation and endplate reactive change associated with a diffuse disc bulge and mild to moderate bilateral facet ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The exiting nerve roots within the neural foramina are surrounded by fat. There is moderate bilateral facet and ligamentum flavum hypertrophy at this level. There is partial effacement of the fat at the lateral recess bilaterally at this level. This is stable compared to the prior exam.At L4-5 there is loss of disc space height, disc desiccation and anterior subluxation of L4 and L5. There are endplate reactive changes present at this level. There is marked bilateral facet and ligamentum flavum hypertrophy present at this level. There is effacement of fat surrounding the left-sided exiting nerve roots associated with disc material and facet hypertrophy resulting in encroachment of the left-sided exiting nerve roots within the left neural foramen. There is effacement of the fat at the lateral recess bilaterally at this level associated with some crowding of the nerve roots within the thecal sac and overall a moderate degree of spinal stenosis. These findings appear stable compared to the previous exam.At L3-4 since the prior exam the patient has developed a broad-based central disc extrusion. Some disc material extrudes behind the L3 inferior endplate. There is associated moderate facet hypertrophy at this level. The facet hypertrophy is worse on the left compared to the right side. There is now crowding of the nerve roots at this level and overall a moderate degree of spinal stenosisAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet and ligamentum flavum hypertrophy at this level. There is crowding of the nerve roots at this level and mild to moderate spinal stenosis. There is accumulation of epidural fat present which contributes to the narrowing of the thecal sac at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.At T10-T11 there is a disc bulge present without significant compromise to the spinal canal.
1.Since the prior exam the patient developed a disc extrusion at L3-4 with new moderate spinal stenosis.2.Since the prior exam or epidural fat has accumulated and is a result of there is now mild to moderate spinal stenosis at L2-3.3.There are multilevel degenerative changes present in lumbar spine which are worse at L4-5 where there is a moderate degree of spinal stenosis and subluxation of L4 on L5 as well as encroachment of the left-sided exiting nerve roots within the neural foramen which is stable since the prior exam.4.There is mild to moderate spinal stenosis at L5-S1 which is stable when compared to prior exam.5.The examination is degraded by patient motion which can obscure more subtle abnormalities.