Clinical question: Rule out right lumbar root compression. Signs and symptoms: Radicular pain RLE. History of prior diskectomy. Nonenhanced lumbar MRI:Lowermost visualized thoracic spine demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- 3 demonstrate moderate disk disease and loss of disk height, minimal ligamentum flavum hypertrophy bilaterally and mild broad base bulging disk. There is mild interval progression of disease since prior exam. There is no spinal stenosis or neural foraminal compromise at this level.L3 -- L4 demonstrate moderate to advanced disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate right neural foraminal compromise secondary to degenerative changes is noted.L4 -- 5 demonstrate advanced disk disease with significant loss of disk height with interval progression since prior exam. There is interval placement of a left transpedicular screw. There is complete resolution of previously seen disk protrusion on the left. No evidence of central spinal stenosis. Mild left neural foraminal compromise is suspected however presence of metallic hardware artifact makes precise assessment difficult. Right neural foramina remains patent.L5 -- S1 demonstrate mild disk disease and degenerative changes of posterior elements. There is a left transpedicular screw placed since prior exam. There is a shallow broad-based disk protrusion in the midline and to the right which results in subtle flattening of thecal sac however without spinal stenosis, lateral recess or neural foraminal compromise.
1.Postoperative changes at L4 -- L5 and with complete resolution of disk protrusion on the left since prior study.2.Mild degenerative changes of lumbar spine however without evidence of spinal canal compromise at any level.3.Very shallow broad-based right sided disk protrusion at L5 -- S1 without spinal canal, neural foraminal or lateral recess compromise.4.Mild neural foraminal compromise as detailed per level above.