Clinical question: Low back pain. Symptoms: Low back pain Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.T10-11, T11-T12, T12-L1 levels are unremarkable other than mild degenerative changes.L1-L2 demonstrate mild disc disease and loss of disc height, shallow broad-based bulging disc, mild bilateral ligamentum flavum and facet degenerative changes. No evidence of spinal stenosis however mild right neural foraminal compromise is detected.L2-L3 demonstrate moderate disc disease and loss of disc height, large disc/osteophyte (R>L) and moderate bilateral ligamentum flavum and facet hypertrophic changes. Constellation of changes results in mass effect and posterior displacement of thecal sac with moderate to severe central spinal stenosis. Degenerative changes also results in moderate bilateral (L>R) neural foraminal compromise and significant compromise of the lateral recesses bilaterally.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral facet and ligamentum flavum hypertrophy, large right lateral osteophyte and a smaller on the left. Constellation of changes results in significant right neural foraminal compromise with no central spinal stenosis and mild to moderate left neural foraminal compromise.L5-S1 demonstrate advanced disc disease and loss of disc height, extensive facet and mild ligamentum flavum hypertrophy changes. There is suggestion of prior posterior bony fusion at this level. No central spinal stenosis however moderate left and mild right neural foraminal compromise is present.L5-S1 demonstrates advanced disc disease and significant loss of disc height, moderate asymmetric left-sided facet hypertrophy and mild on the right. There is suggestion of prior posterior approach surgery at this site and the bony fusion. No spinal stenosis however mild to moderate left neural foraminal compromise is noted.
1.Degenerative changes at L2-L3 and including a large disc-osteophyte results in moderate to severe central spinal stenosis and neural foraminal compromise as detailed.2.Extensive degenerative changes at other levels however without evidence of central spinal stenosis.3.There are multilevel neural foraminal compromise (some severely) as detailed per level above.4.Postoperative changes of prior laminectomy and bony fusion at L4 and L5 without residual central spinal stenosis as detailed.