Clinical question: Evaluate etiology of low back pain. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:Lower most visualized thoracic spine demonstrate asymmetric right ligamentum flavum hypertrophy at T10 level without resultant spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of the visualized thoracic cord.T12-L1 is unremarkable.L1-L2 demonstrate mild disc disease and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height tiny left paramedian disc protrusion with subtle indentation of thecal sac, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, mild grade 1 anterolisthesis, moderate to severe bilateral ligamentum flavum hypertrophy and mild facet disease. There is a right lateral and far lateral broad-based disc protrusion with resultant right lateral recess compromise. Degenerative changes also results in moderate right neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height, moderate to severe bilateral ligamentum flavum hypertrophy, moderate left and mild right facet hypertrophic changes and including mild left facet widening and effusion and a tiny suspected left sided synovial cyst projecting into the left neural foramina (sagittal T2/T2 STIR images 3 and 4 and axial T2 series 601 image 9). There is a central disc protrusion present. Constellation of changes results in mild central spinal stenosis, significant left and moderate to significant right neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease/hypertrophy (left greater than right). Constellation of findings results in significant left and moderate right neural foraminal compromise without central spinal stenosis.Incidental note is made of fatty deposit within the filum terminale along its inferior segment at L5 level. There is however normal termination of the cord at lower L1 level.
1.Degenerative changes at L3-L4 and including a right lateral and far lateral disc protrusion results in mild grade 1 anterolisthesis, moderate right neural foraminal and right lateral recess compromise and no central spinal stenosis.2.Advanced degenerative changes at L4-L5 results in mild central spinal stenosis and significant left and moderate right neural foraminal compromise. Please see above detailed report.3.Degenerative changes at L5-S1 level with resultant significant left and moderate right neural foraminal compromise without central spinal stenosis.4.Fatty density of the lower filum terminale at the L5 level however with normal termination of the cord at lower L1 level.5.Please see detailed report per level above.