Clinical question: New symptoms, evaluate for syrinx and tethered cord. Signs and symptoms: Numbness pelvic area and occasional incontinence, stool. Nonenhanced lumbar MRI:Comparison of sagittal T2 on prone and supine demonstrate anterior movement of the lower thoracic cord, conus and proximal cauda equina on prone series.The signal intensity of vertebral column is unremarkable other than mild changes secondary to degenerative disease.There is normal signal intensity of the lowermost visualized thoracic cord and conus and with normal termination of the cord at the L1 -- L2 disk level.The signal intensity of the cauda equina is within normal and in particular no areas of fatty deposition is detected.T12 -- L1, L1 -- L2 and L2 -- L3 levels are unremarkable with the exception of mild degenerative changes of posterior elements.L3 -- L4 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild facet disease without spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild disk disease, moderate to severe bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes result seen mild central spinal stenosis and bilateral neural foraminal compromise.L5 -- S1 demonstrate advanced disk disease, loss of disk height, associated adjacent endplate Modic signal changes, mild facet and ligamentum flavum hypertrophic changes. No spinal stenosis or significant neural foraminal compromise.Limited lower thoracic spine demonstrate moderate disk disease and loss of disk height at T10 and T11 levels without spinal stenosis are mild bilateral neuroforaminal compromise at T10 -- T11 is present.
1.No evidence of tethered cord.2.Degenerative changes at L4 -- L5 results in mild central spinal stenosis and bilateral neural foraminal compromise.3.Advanced disk disease and to a lesser degree hypertrophic changes of posterior elements at L5 -- S1 without spinal stenosis or neural foraminal compromise.