Clinical question: Sciatica. Signs and symptoms: Sciatica. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.There is marrow signal changes of vertebral column secondary to degenerative disease and unremarkable signal intensity of vertebral column otherwise.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild disc desiccation and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. A shallow left paramedian disc protrusion results in subtle mass effect on the left L4 nerve root in the left lateral recess. Mild central spinal stenosis and no neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild facet hypertrophic changes without evidence of central spinal stenosis. There is a left paramedian and left lateral disc-osteophyte complex present with resultant left lateral recess compromise however without detectable mass effect on the nerve roots. There is evidence of a prior left-sided laminectomy at this level. Mild left neural foraminal compromise and patent right.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy changes. There is a central and right lateral shallow broad-based disc protrusion which results in subtle indentation of the thecal sac. No central spinal stenosis. Unremarkable perispinal soft tissues.
1.At L3-L4 there is a shallow left-sided broad-based disc protrusion resulting in mild left lateral recess compromise and mass effect on the left L4 nerve root. Mild central spinal stenosis and no neural foraminal compromise.2.At L4-L5 there is evidence of a left-sided laminectomy, no central spinal stenosis. Left-sided disc/osteophyte complex is noted.3.At L5-S1 there is a shallow right paramedian disc protrusion with subtle indentation of thecal sac without spinal stenosis.