Clinical question: L4 -- L5 disk disease? Signs and symptoms: Weakness dorsi flexion of great toe and ankle with LBP. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column however mild straightening of lordosis is noted which may be positional or pain related.Examination at T11 -- T12 through L2 -- L3 levels are unremarkable.L3 -- L4 demonstrate mild disk disease and loss of disk height/signal, mild bilateral ligamentum flavum hypertrophy and minimal facet disease. There is a short horizontal band of T2/T2 stir hyperintensity in the annulus of the disk in the midline consistent with an annular fissure (axial T2 series 701 image 12 and sagittal T2, T2 stir image 8. There is no spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease with loss of T2 signal intensity and height. Mild bilateral ligamentum flavum and facet degenerative and hypertrophic changes are present. There is a large right-sided disk extrusion with significant mass effect on the thecal sac, significant right lateral recess compromise and mild central spinal stenosis. Patent neural foraminal bilaterally.L5 -- S1 demonstrate mild disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and minimal facet disease. There is a linear T2 hyperintensity in the annulus of the disk in the midline suggestive of annular fissure is present. There is no spinal stenosis, neural foraminal or lateral recess compromise.Perispinal soft tissues including bilateral kidneys are identified and without gross evidence of abnormality.
1.Large right lateral disk extrusion at L4 -- L5 with resultant significant right lateral recess compromise and mild central spinal stenosis.2.No spinal stenosis or neural foraminal compromise at any other level.3.Mild degenerative changes including annular fissures at L3 -- L4 and L5 -- S1 levels as detailed.4.Unremarkable exam at all other levels.