Clinical question: Possible sacroiliitis. Signs and symptoms: New right low back pain. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild disk desiccation and mild hypertrophic changes of posterior elements without spinal stenosis or neural foraminal compromise. A tiny right lateral disk protrusion noted on prior exam is significantly less conspicuous on current study and likely representing improvement.L1 -- L2 is unremarkable with the exception of mild degenerative changes. Stable since prior study.L2 -- L3 demonstrate mild disk desiccation and loss of disk height, mild to moderate ligamentum flavum hypertrophy and mild facet disease. There is decrease in transverse diameter of thecal sac secondary to hypertrophic ligamentum flavum similar to prior exam. No central spinal stenosis and AP axis and no neural foraminal compromise.L3 -- L4 demonstrate moderate disk desiccation and loss of disk height, moderate to severe right facet and ligamentum flavum hypertrophy and including right facet effusion, mild left facet and ligamentum flavum hypertrophy. Degenerative changes demonstrate no significant interval change however a previously noted centrally located disk protrusion at this level demonstrate interval increased size and with resultant significant left lateral recess and left neural foraminal compromise, mild mass effect on the ventral aspect of the thecal sac and mild central spinal stenosis.L4 -- L5 demonstrate mild disk desiccation and loss of disk height, moderate bilateral (right greater than left) facet and ligamentum flavum hypertrophy. There is a tiny centrally located disk protrusion without interval change since prior exam and with very subtle indentation on thecal sac. No central spinal stenosis. There is no moderate right and mild left neural foraminal compromise without significant change since prior study.L5 -- S1 demonstrate mild degenerative disk disease and no significant degenerative changes of posterior elements. No central spinal stenosis or neural foraminal compromise.Additional MRI sequences were acquired for assessment of the SI joints which demonstrate no detectable signal abnormality of the joints or the adjacent bony structures.
1.New since prior exam is interval increased size of central and leftward broad-based disk protrusion at L3 -- L4 with resultant significant left lateral recess and left neural foraminal compromise and mild central spinal stenosis. Extensive degenerative changes at this level and including mild grade 1 anterolisthesis otherwise remain stable.2.Degenerative changes at other levels as detailed however without central spinal stenosis.3.Neuroforaminal compromise as detailed per level above.4.Dictated images for SI joint evaluation were also acquired and demonstrate no abnormality.