Clinical question: Evaluate for disc herniation, spinal stenosis to account for right hip pain. Signs and symptoms: Right hip pain, inability to walk Pre and post enhanced lumbar MRI:Realignment of vertebral column is anatomical.Signal intensity of vertebral column is unremarkable other than changes related to degenerative disease.T12-L1 is unremarkable.L1-L2 is unremarkable. Incidental note is made of a large fluid signal intensity lesion along the superior right kidney consistent with a renal cyst without evidence of hemorrhage which measures approximately 50 x 40 mm in transaxial dimensions. A smaller second cyst on the right measures at 24 x 22 mm. Both cysts were present on prior exam from 2012 and the smaller cyst appears slightly decreased in size since prior exam.L2-L3 demonstrate mild disc and facet/ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, shadow broad-based disc-osteophyte, moderate to severe bilateral ligamentum flavum hypertrophy and mild facet disease.. Mild central spinal stenosis and moderate bilateral neural foraminal compromise is detected. Interval progression of degenerative changes since prior exam.L4-L5 demonstrate moderate disc disease and loss of disc height, significant left facet and mild right facet hypertrophic changes and significant bilateral ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis and moderate bilateral neural foraminal compromise. There is progression of degenerative changes since prior exam.L5-S1 demonstrate advanced disc disease and loss of disc height, significant bilateral ligamentum flavum hypertrophy and moderate facet degenerative changes. There is a broad based disc/osteophyte on the left which in combination with facet hypertrophy results in significant left lateral recess and moderate left neural foraminal compromise. Post enhanced images demonstrate expected subtle enhancement of hypertrophic changes of the ligamentum flavum and superior endplate of L5 and unremarkable otherwise.
1.There is interval progression of degenerative changes of lumbar spine primarily in the lower lumbar levels as detailed.2.Mild Central spinal stenosis at L3-L4 and L4-L5 levels are noted.3.Broad-based disc-osteophyte on the left at L5-S1 level results in significant left lateral recess and moderate left neural foraminal compromise without central spinal stenosis.4.Post enhanced images demonstrate expected mild enhancement, hypertrophic changes and unremarkable otherwise.