Diagnosis: Radiculopathy, lumbar regionClinical question: sacral cyst seen on non infused MRI study Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level which is worse on the right side compared to the left. There is thickening of the right ligamentum flavum associated with synovial cyst which encroaches on the right lateral recess and mildly displaces the nerve roots of the right lateral recess. Compared to the prior exam the synovial cyst has regressed.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral ligamentum flavum hypertrophy present which is worse on the right compared to left side associated with triangulation of the thecal sac. This is stable compared to the previous examAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is mild triangulation of the thecal sac at this level. There is mild ligamentum flavum hypertrophy at this level. There is right worse than left partial effacement of the fat at the lateral recess at this level associated with mild encroachment of nerve roots at the right lateral recess at this level. The encroachment of the nerve root of the right lateral recess is somewhat worse on the current exam compared to the prior exam from June 2013.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.At T12-L1 there is loss of disc space height as well as endplate reactive changes which are heterogeneous on T2 inversion recovery and hypointense on T1. There is associated contrast enhancement. There is a disc bulge present at this level. Compared to the prior exam from 6/21/1913 loss of disc space height and endplate reactive change has progressed.A cystic lesion is present along the anterior aspect of the right kidney which is stable compared to the prior exam.
1.Since the prior exam a synovial cyst at the right lateral recess at L5-S1 has regressed. There is now only mild displacement of the nerve roots of the right lateral recess at L5-S1.2.There is mild encroachment of the nerve roots at the right lateral recess at L3-4 due to degenerative changes which has mildly progressed since the prior exam.3.Mild spinal stenosis at L4-5 is stable.4.Degenerative changes at T12-L1 without compromise to the spinal canal or exiting nerve roots have mildly progressed since the June 2013 exam.