Female, 73 years old, with recent epidural injection, presenting with incontinence. Cord compression MRI:No acute cord compression is seen. However, there is a disc extrusion at L4-5, likely progressed from prior, which is causing a significant narrowing of the spinal canal. Findings are discussed in more detail below. Relatively mild degenerative findings are seen at additional levels.Lumbar spine MRI:A grade 1/2 anterolisthesis of L4 relative to L5 appears similar to prior. Spinal alignment is unremarkable. No concerning marrow signal abnormality is seen.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. No significant neuroforaminal narrowing. No interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Marked left and moderate right facet hypertrophy. Ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. No interval changes. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk with a small superimposed central disk extrusion. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Disk uncovering and disk bulging. A superimposed central disk extrusion with superior extension has substantially increased in size now contributing to a severe spinal canal stenosis with compression of the cauda equina nerve roots. A right foraminal disk protrusion is similar to prior resulting in severe narrowing of the right neural foramen with likely impingement of the exiting nerve root. The left neural foramen remains mildly narrowed similar to prior. L5-S1: Moderate facet hypertrophy. T1/T2 hyperintensity in the disk may reflect disk mineralization or proteinaceous degeneration. Disk bulging and a superimposed central/left paracentral disk extrusion are not significantly changed. Mild effacement of the left ventral thecal sac is unchanged. Mild bilateral foraminal narrowing. No interval changes.
Since the prior examination, a disc extrusion at L4-5 has significantly increased in size resulting in a progressive severe spinal canal stenosis with compression of the nerve roots of the cauda equina. The right neural foramen at this level remains severely narrowed, similar to prior, due to a foraminal disc protrusion which is unchanged.