Female, 27 years old, with sciatic neuropathy. Orthopedic screws are partially visualized traversing the left iliac bone and sacrum. Artifact originating from these screws distorts and somewhat obscures visualization of the left sided sacral foramina.Alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow replacement or marrow edema is detected.The visualized spinal cord and conus are unremarkable. At the L4-5 level, it appears that the left lateral recess is more cystic than on the right and the dura is displaced medially (see image 18 of series 9). The nerve roots of the cauda equina at this level are also relatively shifted to the middle and right aspects of the thecal sac. The left L4 nerve root is, however, visualized and appears normal as it approaches and traverses the neural foramen.At the L5-S1 level, the left lateral recess remains slightly more cystic than the right. In addition, no clear evidence of the left L5 nerve root is seen approaching or entering the neural foramina, and the left L5 dorsal root ganglion is not visualized within the neural foramen.At the S1 level, again, the neural foramen is more cystic than on the right. There does appear to be a thin linear structure traversing the neural foramen (see image 36 of series 6), though it is unclear if this reflects the nerve or a vessel.There is mild disc bulging at L5-S1. The remaining intervertebral discs are unremarkable. No significant disc herniations are seen. No significant spinal canal or neuroforaminal stenosis is evident at any level. Mild to moderate facet hypertrophy affects L4-5 and L5-S1.
1. The left lateral recess at L4-5 is more cystic than the right, and it appears that the dura is displaced medially by this process. Findings are suggestive of a posttraumatic pseudomeningocele, less likely a dilated perineural root sleeve cyst. Of note, the left L4 nerve root is visualized traversing and exiting the neural foramen.2. At the L5-S1 level, again the lateral recess on the left is more cystic than the right and there is a general displacement of nerve roots towards the middle and right aspect of the thecal sac. At this level, however, no definite evidence of an L5 nerve root is seen either approaching or within the neural foramen. This may reflect atrophy or retraction of an injured L5 nerve root.3. The left S1 neural foramen is more cystic than the right. A thin linear structure does traverse this foramen, though it is unclear if this represents an atrophied S1 nerve root or perhaps just a vascular structure. In either event, posttraumatic injury to the nerve with a possible pseudomeningocele is again suspected.