Clinical question: Evaluate for progression of spinal stenosis, worsened pain after fall one year ago. Signs and symptoms: Back pain radiating down lateral right thigh. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable and stable since prior exam.T12-L1 is unremarkable and stable since prior study.L1-L2 demonstrate mild disc desiccation and mild bilateral facet and ligamentum flavum hypertrophy. Findings at this level results in mild central spinal stenosis which has progressed since prior study. Mild bilateral neural foraminal compromise remains however very similar to prior exam.L2-L3 demonstrates advanced disc disease and loss of disc height with mild interval progression. Mild to moderate bilateral facet and ligamentum flavum hypertrophy is also noted without convincing evidence of change. Findings results in moderate to severe central spinal stenosis without significant change. There is a lateral and far lateral right-sided disc protrusion (axial T2 series 1001 image 18 and sagittal T2/T2 stair image 12). This finding results in compromise of right neural foramina and with mass effect and superior displacement of right L2 nerve root. Degenerative changes results in mild-to-moderate left neural foraminal compromise without significant change.L3-L4 demonstrate advanced disc disease and loss of disc height with mild interval progression. There is asymmetrical right-sided disc bulge or broad-based disc protrusion which results in compromise of the right neural foramina and mass effect on the right L3 nerve root. There is subtle interval progression of these findings since prior exam. Moderate to severe left neural foraminal compromise is again noted without appreciable change. Moderate central spinal stenosis with suggestion of slight interval progression since prior study at this level is also noted.L4-L5 demonstrate moderate disc disease and moderate bilateral ligamentum flavum hypertrophy with mild facet disease. No spinal stenosis however mild left neural foraminal compromise is present. There is subtle interval progression of disease.L5-S1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.The perispinal soft tissues remain unremarkable.
1.Extensive degenerative changes at L2-L3 with resultant moderate to severe central spinal stenosis without significant change. There is a new right-sided disc protrusion with further compromise of right neural foramina and mass effect on the right L2 nerve root.2.Extensive degenerative changes at L3-L4 with resultant central spinal stenosis and neural foraminal compromise with mild progression as detailed.3.Mild degenerative changes at L1-L2 with interval progression and new mild central spinal stenosis.4.Please review detailed report per level above.