Clinical question: Chronic low back pain, L4-L5 degenerative disc disease on x-ray. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:Examination demonstrates uniformly smaller than expected caliber of the lowest visualized thoracic and lumbosacral spine which is believed to represent anatomical variation of congenital small canal/short pedicles.Visualized T10-T11 only on sagittal series demonstrates moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements which in combination with congenitally small caliber of the spinal canal results in central spinal stenosis and moderate bilateral neural foraminal compromise secondary to degenerative disease.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate moderate to advanced disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a left lateral disc-osteophyte complex with subtle mass effect on the thecal sac and with resultant mild to moderate central spinal stenosis and moderate left neural foraminal compromise.L2-L3 demonstrate mild disc desiccation, mild bilateral ligamentum flavum hypertrophy and mild facet disease. Mild bilateral neural foraminal compromise and central spinal stenosis.L3-L4 demonstrate moderate disc disease and loss of disc height, mild bulging disc, moderate bilateral ligamentum flavum and facet hypertrophy (L>R). Mild bilateral facet effusion. Above findings in combination with congenitally small canal results in moderate central spinal stenosis, moderate left and moderate to severe right neural foraminal compromise.L4-L5 demonstrate moderate to advanced disc disease and loss of disc height, there is a large central and left lateral disc-osteophyte complex, moderate left and mild to moderate right facet and ligamentum flavum hypertrophy. Constellation of findings results in severe central spinal stenosis, significant left and moderate right neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis however there is significant bilateral neural foraminal compromise primarily secondary to hypertrophic changes of posterior elements.
1.There is generalized smaller than expected caliber of the lower most visualized thoracic and thoracolumbar spine believed to represent a congenital anatomical variation.2.Mild to moderate degenerative changes at T10-T11 with resultant central spinal stenosis as detailed.3.Degenerative changes at L3-L4 and including a small left lateral disc-osteophyte complex results in central spinal stenosis.4.Degenerative changes at L3-L4 in combination with congenitally small canal with resultant moderate central spinal stenosis.5.Extensive degenerative changes at L4-L5 and including a large left lateral disc-osteophyte complex results in significant left lateral recess and significant central spinal stenosis.6.There is also evidence of multilevel neural foraminal compromise as detailed per level above.