Clinical question: Evaluate for nerve root compression and acuity of the L4 compression fracture. Signs and symptoms: Extremely L4 compression fracture, right lower extremity pain. Pre and post enhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is mild compression deformity of the superior endplate of L4 without associated marrow signal edema or abnormal enhancement. Finding is consistent with a chronic compressive deformity. The signal intensity of vertebral column is unremarkable on sagittal T2 STIR series.T12-L1 through L3-L4 levels demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and to a lesser degree facet hypertrophic changes. There is a right lateral and far lateral broad-based disc protrusion with resultant significant compromise of right neural foraminal. No spinal stenosis and patent left neural foraminal.L5-S1 demonstrate mild degenerative disc, moderate right lateral (right greater than left) facet hypertrophic changes however without spinal stenosis or neural foraminal compromise.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina without abnormal enhancement.
1.Mild chronic compression deformity of the superior endplate of L4.2.Normal signal intensity and anatomic alignment of vertebral column.3.At L4-L5 there is a large right lateral and far lateral broad-based disc protrusion with significant right neural foraminal compromise and no central spinal stenosis.4.No spinal stenosis or neural foraminal compromise at any level otherwise. No abnormal enhancement. Please review detailed report per level above.