Clinical question: 72-year-old female with spine surgery with low back pain. Evaluate for progression of disease. Signs and symptoms: Low back pain. Pre-and post-enhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 demonstrate minimal degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild disk disease, mild bilateral (left greater than right) facets and ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise. Incidental note is made of a single large left renal cyst measuring at approximately 43 mm in transaxial dimensions.L2 -- L3 demonstrate mild disk desiccation, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is resultant mild central spinal stenosis at this level which appears to be primarily secondary to hypertrophic changes of posterior elements/ligamentum flavum. No neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, mild grade 1 anterolisthesis, chronic postoperative changes at this level are also noted. There is no spinal stenosis. There is compromise of bilateral neural foraminal with mass effect on the exiting nerve roots best appreciated on sagittal images.L4 -- L5 demonstrate moderate to advanced disk disease, significant loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild (left greater than right) facets hypertrophic changes. There is a large broad-based central and to the right disk protrusion at this level. Constellation of above findings results in moderate central spinal stenosis and significant lateral recess compromise bilaterally. No significant neural foraminal compromise.L5 -- S1 demonstrate mild disk desiccation moderate bilateral ligamentum flavum hypertrophy and minimal facet disease. No spinal stenosis or appreciable neural foraminal compromise. There is however compromise of the lateral recess of the canal at this level bilaterally (left greater than right). Post enhanced images demonstrate expected enhancement of degenerative changes of the articulating facets in particular at L2 -- L3 level and is unremarkable otherwise.
1.Degenerative changes at L2 -- L3 in particular of the ligamentum flavum results in mild central spinal stenosis.2.Degenerative changes at the L3 -- L4 and including mild grade 1 anterolisthesis without spinal stenosis however with compromise of bilateral neural foramina as detailed.3.Extensive degenerative changes at L4 -- L5 and a broad-based disk protrusion results in central spinal stenosis and lateral recess compromise bilaterally as detailed.4.Degenerative changes at L5 -- S1 with resultant lateral recess compromise bilaterally.5.Post enhanced images are unremarkable.