Clinical question: Back pain. Signs and symptoms: Back pain Nonenhanced lumbar MRI:The alignment of which column is clinical.Unremarkable lower most visualized thoracic spine and thoracic cord.T12 -- L1 is unremarkable.L1 -- L2 demonstrates mild disk desiccation without spinal canal or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild (left greater than right) facet degenerative changes. Constellation of changes results in mild central spinal stenosis and mild left neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, asymmetric moderate left facet and ligamentum hypertrophy and to a lesser degree on the right is present. There is a large central disk extrusion at this level with resultant significant mass effect on the thecal sac and result in significant central spinal stenosis. Moderate left and mild to moderate right neural foraminal compromise is also present.There is more than 50% compression deformity of the superior endplate of L3 vertebrae. There is increased T2 and decreased T1 signal intensity compressed vertebrae which could represent edema. Please correlate with history regarding recent trauma/fall since the signal changes of marrow space may indicate edema secondary to recent fracture.L4 -- L5 demonstrate moderate disk disease and loss of disk height, asymmetric (left greater than right) moderate ligamentum flavum hypertrophy and facet disease. There is a small centrally located disk protrusion projecting into the ventral epidural space and without significant mass effect on the thecal sac. There is no spinal stenosis, however significant right and moderate left neural foraminal compromise is present.L5 -- S1 demonstrate moderate (left greater than right) facet hypertrophic changes and ligamentum flavum hypertrophy. No central spinal stenosis. Moderate to severe bilateral neural foraminal compromise is present.
1.L3 -- L4 there is advanced degenerative disk disease, large central disk extrusion with resultant significant central spinal stenosis. Bilateral neural foraminal compromise at this level is also present as detailed. More than 50% compression fracture of L4 vertebrae is noted without malalignment. T2/T2 stir hyperintensity of L4 vertebrae although could represent degenerative Modic signal changes, possibility of edema as result of recent fracture cannot be excluded. Correlate with history for recent fall or trauma to the back.2.Mild central spinal stenosis at L2 -- L3 is also noted and unremarkable at all other levels.3.Multilevel neural foraminal compromise (some significantly) as detailed per level above.