Clinical question: Evaluate for lower back pain. Signs and symptoms: Back pain, sciatic pain. Nonenhanced lumbar MRI:The lower most visualized thoracic spine and thoracic cord is unremarkable.T12-L1 and L1-L2 level was demonstrate mild degenerative changes and unremarkable otherwise.L2-L3 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a central and leftward broad-based disc protrusion resulting gain significant left lateral recess compromise. Degenerative changes also result in mild central spinal stenosis at this level.L3-L4 demonstrate advanced disc disease and loss of disc height, mild bilateral (right greater than left) ligamentum flavum hypertrophy and to a lesser degree facet hypertrophic changes are noted. Constellation of changes results in mild central spinal stenosis and lateral recesses compromise (right greater than left) as well as mild to moderate right neural foraminal compromise.L4-5 demonstrate advanced disc disease and loss of disc height, moderate bilateral facet and ligamentum flavum hypertrophy and trace anterolisthesis. Although there is mild compromise of the transverse diameter of the thecal sac is no spinal stenosis in AP axis. Degenerative changes however results in moderate left neural foraminal compromise, mild bilateral recess compromise and moderate left neural foraminal compromise.L5-S1 demonstrate advanced disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis. There is a central and left lateral broad-based disc protrusion with mass effect and posterior displacement of left S1 nerve root in the lateral recess. Moderate left neural foraminal compromise secondary to degenerative disease is also noted.Postcontrast images demonstrate expected enhancement of degenerative changes in particular of the facets and ligamentum flavum and unremarkable otherwise.
1.Degenerative changes of lumbar spine with resultant central spinal stenosis at L2-L3 and L3-L4 levels. Mild decreased transverse diameter of the thecal sac at L4/L5 however without central spinal stenosis and AP axis.2.A central and leftward protrusion at L2-L3 level and a central and leftward disc protrusion at L5-S1 levels as detailed above.3.Mild to moderate neural foraminal compromise at multiple levels as detailed per level.4.Unremarkable postcontrast images.5.Please see detailed report per level above.