Diagnosis: Low back pain WeaknessClinical question: new L4 weakness and foot drop with back pain, please evaluate for CES and central stenosisSigns and Symptoms: back pain 4 nonrib-bearing lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. For the purpose of this exam it appears that L5 is incorporated into the sacrum and is sacralized and will therefore be named S1. The conus medullaris on sagittal imaging is grossly intact.There is a formed disc present at S1-S2. At L4-S1 there is a diffuse disc bulge present at this level associated with disc desiccation and some mild to moderate facet and ligamentum flavum hypertrophy. There is mild encroachment of the nerve roots at the lateral recesses bilaterally at this level but worse on the left when compared to the right side.At L3-4 there is a diffuse disc bulge present associated mild ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recesses bilaterally. There is partial effacement of spinal fluid surrounding the nerve roots within the thecal sac and mild encroachment of the nerve roots at the left lateral recess at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Please note that there are 4 nonrib-bearing lumbar-type vertebrae present. Apparently L5 has been incorporated into the sacrum and can be considered S12.There are degenerative changes present in the lower lumbar spine with a mild degree of spinal stenosis at L3-4 with mild encroachment of the nerve roots at the lateral recess on the left side at L3-4 and L4-5.