Clinical question: Cord compression. Signs and symptoms: RLE numbness/weakness. Pre-and post-enhanced lumbar MRI:There is normal anatomical alignment of the vertebral column however with straightening of the lumbar lordosis.Lower most visualized thoracic spine demonstrate mild central spinal stenosis at T10 -- T11 secondary to ligamentum flavum hypertrophy changes posteriorly. There is no detectable signal abnormality in the cord and no axial images of the sella were acquiredT12 -- L1 demonstrate mild degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild disk disease and mild to moderate ligamentum flavum hypertrophy no central spinal stenosis or neural foraminal compromise. Incidental note at this level is made of partially visualized very large left renal cyst. This finding was present on prior MRI exam from 2008. Due to lack of complete visualization of the lesion precise comparison cannot be made however in this limited view the cyst appear grossly stable.L2 -- L3 demonstrate mild disk disease, shallow broad-based bulging disk and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in moderate central spinal stenosis and bilateral (left greater than right)-year-old foraminal compromise.L3 -- L4 demonstrate mild to moderate disk disease, subtle loss of disk height, broad-based bulging disk, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophy changes. There is resultant significant central spinal stenosis and moderate (left greater than right) neuroforaminal compromise.L4 --L5 demonstrate mild disk disease and loss of disk height, broad-based bulging disk, moderate to significant bilateral ligamentum flavum hypertrophy and mild bilateral facet disease. Constellation of changes results in significant central spinal stenosis and moderate bilateral neural foraminal compromise.L5 -- S1 demonstrate mild degenerative disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy, mild facet disease and including bilateral facet diffusion. There is no central spinal stenosis. Moderate right neural foraminal compromise secondary to degenerative changes however is identified.Compared to prior exam from 2008 there is progression of the degenerative changes and progression of multilevel central spinal stenosis as detailed above.Post-enhanced images demonstrate expected subtle enhancement of hypertrophic changes of facets and ligamentum flavum and subtly of the endplates. No abnormal enhancement of the cord, conus or cauda equina.
1.No acute findings.2.Mild to moderate disease and moderate hypertrophic changes of posterior elements throughout the lumbar spine results in central spinal stenosis at L2 -- L3, L3 -- L4 and L4 -- L5 levels.3.Multilevel bilateral neural foraminal compromise as detailed per above. Please see detailed report.4.Progression of disease since prior exam from 2008 and progression of spinal stenosis.5.No concerning abnormal enhancement on post infused images.