Clinical question: Patient is pregnant, known previous HNP assess for new HNP. Signs and symptoms: Pending delivery. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column however the straightening of lumbar lordosis similar to prior study.T12 -- L1 demonstrate minimal degenerative changes and are unremarkable otherwise.L1 -- L2 demonstrate mild disk desiccation and subtle loss of disk height and mild to moderate bilateral ligamentum flavum hypertrophy and minimal facet disease. There is no appreciable interval change. There is no spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophy. There is mild interval progression of disease. There is no spinal stenosis or neural foraminal compromise. Examination at this level mildly degraded due to excessive CSF pulsation artifact which may be related to patient's pregnancy.L3 -- L4 demonstrate mild disk desiccation and mild tube moderate bilateral ligamentum flavum and to lesser degree facet hypertrophic changes. Subtle interval progression of disease. Sagittal images are degraded due to exaggerated CSF pulsation. No convincing evidence of a spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate advanced disk disease with loss of disk height, excessive expectant associated Modic signal changes of the adjacent endplates and moderate (right greater than left) hypertrophy changes of posterior elements. There is interval progression of degenerative changes and including further loss of disk height since prior exam. There is evidence of a right-sided laminectomy at this level. There is a left-sided broad-based disk protrusion which is new since prior exam. The finding results in significant left lateral recess mass effect and to a lesser degree mass effect on the thecal sac. Mild central spinal stenosis and mild right neural foraminal compromise and patent left neural foramina. This finding is best appreciated on axial T2 series 7 image 32 and sagittal T2 series on images 9 and 10.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes. Right-sided laminectomy postoperative changes are noted. There is a shallow leftward broad-based disk protrusion which demonstrates subtle interval increased size. There is resultant left lateral recess compromise however without central spinal stenosis normal or neural foraminal compromise.
1.Advanced degenerative changes at L4 -- L5 with interval progression of disease. New central and left lateral disk protrusion with resultant significant left lateral recess compromise however with patent left neural foramina. Mild right neural foraminal compromise. 2.Left lateral disk protrusion at L5 -- S1 with interval increased size and with resultant left lateral recess compromise as detailed.3.Mild degenerative changes at other levels as detailed per level.