Clinical question: Spinal stenosis. Signs and symptoms: Left lower back pain with radiating pain to left leg. Nonenhanced lumbar MRI:The lower most visualized thoracic spine demonstrate moderate disc disease and loss of disc height at T10-T11 through T12-L1 levels. There are multiple Schmorl nodes at these levels. There is no spinal stenosis however mild angulation of the spinal column at T11-T12 is noted. This appearance is not greatly different than the study from 9-30-15. The marrow signal intensity of the vertebral column is unremarkable.L1-L2 demonstrate mild degenerative changes. There is a left lateral ventral epidural defect which extend into the left neural foraminal (axial T2 series 601 images 30 through 32 and sagittal T1 series 301 images 6 through 8). Finding demonstrate T1 hyperintense and T2/T2 STIR hyperintense signal pattern. The finding is believed to represent an extruded disc fragment which is often mass effect on the thecal sac and significant compromise of the left neural foramina. Less likely possibility of a mass cannot be entirely excluded. Follow-up with enhanced imaging is recommended. Note however should be made that this finding is not associated with any adjacent marrow signal changes of bone. There is no spinal stenosis and the right neural foramina remains widely patent. This finding retrospectively is identified on prior nondedicated lumbar MRI study (cord compression protocol exam) and without definitive change.L2-L3 demonstrate mild degenerative changes of the disc and the posterior elements without central spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild degenerative disc disease, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in mild central spinal stenosis and mild bilateral neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild grade 1 anterolisthesis, extensive bilateral (L>R) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. Degenerative changes of facet on the left includes a loculated synovial cyst arising from the superior aspect of the left articulating facet (sagittal T2 series 501 image 3). Changes at this level results in moderate central spinal stenosis and with significant right and moderate to significant left neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height however with extensive left and moderate right facet hypertrophic changes and mild to moderate bilateral ligamentum flavum hypertrophy. There is no spinal stenosis however moderate right neural foraminal compromise is present.
1.L1-L2 demonstrate a ventral left lateral soft tissue density suspected of an extruded disc which occupies the left neural foramina and with mild mass effect on the thecal sac without central spinal stenosis. This finding is not associated with any adjacent bone marrow signal changes. Possibility of a mass although is considered less likely, however follow-up with postcontrast imaging is recommended for further assessment.2.Mild degenerative changes at other levels however with disproportionate extensive degenerative/hypertrophic changes of the articulating facets in particular at L4-5 and L5-S1 levels as detailed above.3.There is mild central spinal stenosis at L3-L4 and moderate central spinal stenosis at L4-L5.4.Multilevel neural foraminal compromise as detailed per level above.