Diagnosis: Displacement of lumbar intervertebral disc without myelopathy. Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: hx lumbar disc herniation. Eval for new abnormality or reherniationSigns and Symptoms: back pain, Left leg pain, left big toe numbness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a high T1 signal lesion present within the L4 vertebral body which is a on the right half of the vertebral body and measures 13 x 12 mm sagittal dimensions and most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a left lateral disc protrusion present which extends into the left neural foramen and encroaches on the left-sided exiting nerve root. Additionally there is a sequestered fragment present at the left lateral recess behind the L4 vertebral body. This sequestered fragment was not present on the prior exam. The lateral disc protrusion was present on the prior exam and has mildly progressed. There is redemonstration of loss of disc space height and disc desiccation at this level. High signal foci on T2 imaging are present within the disc protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are small Schmorl's nodes present at T12-L1 and T11-T12 along the corresponding superior endplates.
Since the prior exam in addition to the left lateral disc protrusion encroaching the exiting nerve roots on the left-side at L4-5 which has progressed, the patient has developed a disc fragment which is at the left lateral recess behind the L4 vertebral body affecting the nerve roots at the left lateral recess.