Clinical question: Evaluate for right paramedian HNP explain right radicular symptoms. Signs and symptoms: Right radiating leg pain. Nonenhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 demonstrate minimal bilateral facet effusion/fluid signal intensity and unremarkable otherwise.L2 -- L3 demonstrate mild disk desiccation, moderate right and mild left ligamentum flavum hypertrophy and mild (right greater than left) facet hypertrophic changes. There is no spinal stenosis. However a symmetric right-sided hypertrophic changes of posterior elements results in moderate right neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy, mild left facet effusion. There is a central and right-sided broad-based disk protrusion with resultant mass-effect and posterior displacement of the right exiting nerve root within the lateral aspect of the spinal canal however without extension into the right neural foramina. This finding also results in moderate central spinal stenosis. Patent left neural foramina.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is no evidence of central spinal stenosis in the AP axis however mild decrease caliber of thecal sac secondary to mass effect by hypertrophied ligamentum flavum is noted. There is no central spinal stenosis however mild compromise of the lateral recess of the canal bilaterally is noted.L5 -- S1 demonstrate minimal degenerative disk disease, mild bilateral facet and ligamentum flavum hypertrophy. There is a central and left lateral and far lateral broad-based disk protrusion which results in moderate left neural foraminal compromise. Mild right neural foraminal compromise is also present.
1.At L3 -- L4 there is a central and rightward broad based disk protrusion with resultant mass-effect and posterior displacement of the exiting right nerve root at this level and moderate central spinal stenosis.2.At L5 -- S1 there is a shallow broad-based disk protrusion on the left and extending far laterally with resultant moderate left neural foraminal compromise without central spinal stenosis.3.At L4 -- L5 there is mild decreased caliber of thecal sac in transverse axis secondary to ligamentum flavum hypertrophy changes.4.Please see above comments per level for degenerative disk disease, hypertrophic changes of posterior elements including facet effusion.