Clinical question: Rule out lumbar stenosis. Signs and symptoms: Weakness in left ankle dorsiflexor, numbness and sacral than left, region, increased weakness when walks. Nonenhanced lumbar MRI:T11-T12 demonstrates advanced disc disease and loss of disc height and mild central spinal stenosis.T12-L1 demonstrate mild degenerative disc disease, mild bilateral ligamentum flavum hypertrophy and facet disease. There is a small right-sided ligamentum flavum synovial cyst measuring 5 x 6 mm in transaxial dimensions and 13 mm in cranial cephalad axis. Finding is best appreciated on axial T2 series 5 image 4, sagittal T2 STIR series 4 image 9. Findings results in effacement of right posterior subarachnoid space without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is resultant mild central spinal stenosis and bilateral neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate to significant bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of findings results in moderate to severe central spinal stenosis and mild to moderate bilateral neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. Constellation of findings results in moderate to severe central spinal stenosis and severe left neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height, significant bilateral (L>R) ligamentum flavum hypertrophy and moderate facet hypertrophic changes. Degenerative changes also resulting in grade 1 anterolisthesis and significant central spinal stenosis and bilateral (L>R).L5-S1 demonstrate moderate to advanced disc disease and loss of disc height, diffuse broad-based pseudo bulge of disc, and moderate bilateral ligamentum flavum hypertrophy. Degenerative changes also results in mild grade 1 anterolisthesis and moderate central spinal stenosis and bilateral neural foraminal compromise.
1.Extensive degenerative changes of lumbar spine with resultant grade 1 anterolisthesis at L4-L5 and to a lesser degree at L5-S1 levels.2.Severe central spinal stenosis at L2-L3, L4-5 and L5-S1 levels and to a lesser degree at L1-L2 and L3-L4 level as detailed above.3.Multilevel neural foraminal compromise (some significantly) as detailed per level above.4.There is a right ligamentum flavum synovial cyst at L2-L3 as detailed/measured above.5.Partially evaluated lower thoracic spine demonstrate mild central spinal stenosis at T11-T12.