Clinical question: Low back pain. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.The signal intensity of the vertebral column is unremarkable other than changes related to degenerative disease.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild degenerative disc disease, mild ligamentum flavum hypertrophy, minimal T2 hyperintensity of the bilateral articulating facets suggestive of effusion. There is a tiny right-sided synovial cyst projecting posterior to the articulating facet at this level measuring 5 x 8 mm in transaxial dimensions (axial T2 series 6 image 18). No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate minimal degenerative disc disease, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease and including increased T2/T2 STIR signal intensity of the facet spaces suggestive of effusion. No spinal stenosis however mild right neural foraminal compromise is noted.L4-L5 demonstrate minimal disc disease, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate advanced disc disease and loss of disc height, mild bilateral facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.On axial and sagittal T1-weighted there is a long segmental fatty filum terminale measuring maximum of 5 x 3 mm in transaxial dimensions at L2 level. The finding could represent a tethered cord however there is normal termination of the cord at L1-L2 disc level.
1.Moderate to advanced disc disease at L5-S1 level and minimally at other levels as detailed.2.No evidence of spinal stenosis at any level.3.Mild neural foraminal compromise as detailed per level above.4.Fluid signal intensity within the articulating facets and including a synovial cyst posterior to articulating facet on the right at L2-L3 level as detailed.5.Long segmental fatty filum terminale measuring maximum of 5 x 3 mm in transaxial dimensions however with normal termination of the cord at the L1-L2 disc level.