Clinical question: 87-year-old female with right buttock pain. Evaluate for spinal stenosis versus degenerative disease and neural foraminal compromise. Signs and symptoms: As above. Nonenhanced lumbar MRI:Examination demonstrates mild dextroscoliosis centered at L3-L4 level which is best appreciated on coronal T2-weighted series 301. There is normal anatomical alignment of vertebral column.The lower most visualized thoracic spine from T10 inferiorly is negative for spinal stenosis however advanced degenerative disc disease at T10-T11 in particular is noted.T12-L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophic changes and mild facet disease. Constellation of changes results in mild central spinal stenosis and with mild bilateral neural foraminal compromise.L2-L3 demonstrate mild disc disease with shallow diffuse bulging disc, significant bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in moderate central spinal stenosis and moderate left neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, diffuse asymmetric bulging disc in the midline and to the left and significant bilateral ligamentum flavum hypertrophy with mild facet disease. Constellation of changes results in moderate to significant central spinal stenosis and significant left lateral recess compromise (due to asymmetric bulging disc). Moderate right neural foraminal compromise and mild on the right.L4-L5 demonstrate advanced degenerative disc disease with near complete loss of disc height, shallow broad-based bulging disc and hypertrophic spur is present. Severe bilateral ligamentum flavum hypertrophy and mild degenerative facet disease is noted. Constellation of changes results in significant central spinal stenosis, significant right lateral recess compromise and moderate bilateral neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis however moderate lateral recess compromise bilaterally is noted. There is also severe asymmetric right-sided neural foraminal compromise.
1.Degenerative changes of the lumbar spine with resultant significant central spinal stenosis at L3-L4 and L4-L5 levels and to a lesser degree at L2-L3 as detailed.2.Multilevel bilateral neural foraminal and lateral recess compromise as detailed per level above.