Clinical question: Lumbar polyradiculopathy; rule out spondylolysis, rule out spinal stenosis. Signs and symptoms: Numbness in lower extremities, weakness in distal lower extremities. LBP. EMG showed polyradiculopathy (cervical, thoracic and lumbar). Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild disc desiccation and loss of height and moderate hypertrophic changes of posterior elements. There is resultant mild central spinal stenosis, moderate right and severe left neural foraminal compromise.C3-C4 demonstrate mild disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy. There is also hypertrophic changes of posterior longitudinal ligament throughout the cervical spine. Constellation of finding at this level results in moderate central spinal stenosis, significant right and moderate to significant left neural foramina compromise.C4-C5 demonstrate moderate disc disease and mild bilateral facet and ligamentum flavum hypertrophy as well as posterior longitudinal ligament hypertrophy. Constellation of changes results in mild central spinal stenosis and severe bilateral neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, ventral disc/osteophyte complex and mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis, significant bilateral (L>R) neural foraminal compromise.C6-C7 demonstrate fusion at the level of the disc likely secondary to degenerative changes without central spinal stenosis. There is however moderate bilateral neural foraminal compromise secondary to degenerative disease.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.The signal intensity of the cervical and upper most visualized thoracic cord remains within normal.Partially visualized images through posterior fossa demonstrate atrophic changes of the right inferior cerebellum suspected of a chronic ischemic stroke.Nonenhanced lumbar MRI:The lower most visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral facet and mild bilateral ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and moderate left neural foraminal compromise.L3-L4 demonstrate mild disc disease with loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is increased dorsal epidural fat pad with resultant mass effect on the thecal sac. Constellation of changes results in moderate central spinal stenosis, significant right and moderate left neural foraminal compromise.L4-L5 demonstrate mild disc disease and loss of disc height, significant bilateral ( R>L) facet and ligamentum flavum hypertrophy and with increased dorsal epidural fat pad. Degenerative changes also results in mild grade 1 anterolisthesis. Constellation of changes results in severe central spinal stenosis, significant right and moderate left neural foraminal compromiseL5-S1 demonstrate mild disc disease and loss of disc height, significant left and moderate right facet and ligamentum flavum hypertrophy. No central spinal stenosis however moderate to severe right neural foraminal compromise is detected.The signal intensity of cauda equina remains within normal.AP spinal soft tissues are unremarkable.Partially visualized bilateral SI joints demonstrate mild degenerative changes.
1.Nonenhanced MRI of cervical spine demonstrate extensive degenerative and hypertrophic changes with resultant multilevel mild to moderate central spinal stenosis and multilevel bilateral significant neural foraminal compromise (some significantly) as detailed per level above. There is normal signal intensity of the visualized cord. There is disc space fusion at C6-C7 likely secondary to degenerative disease. Atrophic changes of the inferior right cerebellum suggestive of chronic stroke.2.Nonenhanced lumbar MRI demonstrate degenerative changes and including mild grade 1 anterolisthesis at L4-L5 which in combination with increased dorsal epidural fat results in multilevel central spinal stenosis and neural foraminal compromise as detailed per level above.