Clinical question: Evaluate for disk disease. Signs and symptoms: Patient with back pain radiating to her left leg. Pre-and post-enhanced lumbar MRI:The signal intensity of vertebral column is unremarkable other than changes related to degenerative disease.The alignment vertebral column is abnormal and with evidence of mild grade 1 anterolisthesis at L5 -- S1 secondary to degenerative disease.Lower most visualized thoracic spine and thoracic cord from T10 inferiorly are unremarkable.T12 -- L1, and one that showed to, L2 -- L3 and L3 -- L4 levels are unremarkable for spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild ligamentum flavum and facet hypertrophy, slight widening of the bilateral facet spaces with fluid signal intensity suggestive of bilateral facet inflammatory changes or fluid/effusion. There is a small synovial cyst projecting posterior and inferior to the right articulating facet at this level (axial T2 series 5 image 27 and sagittal T2/T2 stir image 11). There is expected enhancement of hypertrophic changes of posterior elements on post enhanced images. There is no central spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate moderate to advanced disk disease and loss of disk height, moderate bilateral facet and to a lesser degree ligamentum flavum hypertrophy. There is slight widening of the facet space and with T2 hyperintensity of on the left with expected subtle enhancement similar to L4 -- L5 level. There is no central spinal stenosis however moderate to severe left neural foraminal compromise is present at this level.
1.Examination at T10 -- T11 to L3 -- L4 levels are unremarkable.2.At L4 -- L5 there is extensive degenerative changes of facets and ligamentum flavum and including widening of facet displacement T2 hyperintensity suggestive of inflammatory changes or facet fusion. There is expected enhancement of these changes as detailed above. There is no central spinal stenosis or neural foraminal compromise. A small synovial cyst projecting posterior to right articulating facet is also noted.3.At the L5 -- S1 there is moderate to advanced disk disease and degenerative changes of posterior elements without central spinal stenosis. There is however moderate to severe left neural foraminal compromise.4.Post enhanced images demonstrate expected enhancement of degenerative changes of posterior elements at the L4 -- L5 and L5 -- S1 levels and unremarkable otherwise.