Clinical question: Chronic low back pain, difficulty bending over to pick things up. Signs and symptoms: As above. Nonenhanced lumbar MRI:The alignment of vertebral column remains anatomical.There is a well-demarcated focus of T1 and T2 hyperintensity in the vertebral body of L4 measuring approximately 19 mm in size and consistent with a hemangioma. A tiny additional hemangioma is also noted in the body of S2 vertebrae.Examination at T11 -- T12, T12 -- L1, L1 -- L2 levels demonstrate minimal degenerative changes however without spinal stenosis or neural foraminal compromise. Incidental note is made of a small right renal cyst.L3 -- L4 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum hypertrophy. Additionally there is a band of T2 hyperintensity and T1 hypointense along the adjacent endplates consistent with Modic signal changes. There is no evidence of spinal stenosis. No significant neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and mild loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. There is mild to moderate right neural foraminal compromise and unremarkable on the left. There is a linear increased T2/T2 stir signal intensity within the annulus of the disk laterally and far laterally on the right consistent with an annular fissure.L5 -- S1 is unremarkable other than mild facet and ligamentum flavum hypertrophy.
1.Degenerative changes of disks and posterior elements are noted however without evidence of central spinal stenosis at any level.2.Mild neural foraminal compromise as detailed per level above.3.There are multiple skeletal hemangiomas present as mentioned above.4.Right lateral and far lateral annular fissure at L4 -- 5 as detailed above.