Clinical question: Low back pain, evaluate lumbar spine. Signs and symptoms: Lower back pain and left leg pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column however with straightening of lumbar lordosis. The signal intensity of vertebral column is unremarkable.T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise.L3 -- L4 demonstrate mild degenerative changes however without central spinal stenosis. Moderate bilateral neural foraminal compromise is noted on sagittal T2 weighted images. There is suggestion of congenital anatomical variation of short pedicle causing the neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height and a central and left broad-based disk protrusion. The findings results in moderate central spinal stenosis. There is also moderate bilateral neural foraminal compromise. The degree of neural foraminal compromise appears is disproportionate to the extent of degenerative changes and a component of congenitally short pedicles as a cause of neural foraminal stenosis is highly suspected.L5 -- S1 demonstrate mild disk disease and mild bilateral facet and ligamentum flavum degenerative changes. No spinal stenosis or convincing evidence of neural foraminal compromise.The perispinal soft tissues are unremarkable.
1.Central and left sided broad-based disk protrusion at L4 -- L5 with resultant central spinal stenosis and moderate bilateral neural foraminal compromise.2.Minimal degenerative changes at other levels with highly suspected congenital anatomical variation of short pedicles results in neural foraminal compromise as detailed per level above.