Clinical question: Sciatica, right S1 radiculopathy on the MG. Signs and symptoms: Right posterior lower back pain. Pre and post enhanced brain MRI:Examination at T11-T12, T12-L1, L1-L2, L2-L3, L3-L4 and L4-L5 levels are unremarkable with the exception of mild degenerative changes. No spinal stenosis or neural foraminal compromise and no detectable abnormal enhancement.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral (R>L) facet and ligamentum flavum hypertrophy. Additionally there is a large central and right para median disc extrusion with resultant mass effect on the thecal sac with subtle indentation and significant right lateral recess compromise and including mass effect on the right S1 nerve root is laterally and posteriorly displaced. No central spinal stenosis or neural foraminal compromise. There is expected enhancement of extruded disc.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina without abnormal enhancement. Unremarkable paraspinal soft tissues.
1.At L5-S1 level there is a central and rightward disc extrusion with resultant compromise of right lateral recess, mass effect and posterior displacement of right S1 nerve root as detailed. No spinal stenosis or neural foraminal compromise at this level. Mild degenerative changes however are noted at this level.2.Unremarkable pre and post enhanced lumbar MRI otherwise.