Clinical question: Etiology of sciatica. Signs and symptoms: Right leg/buttock shooting pain, paresthesia. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral, however with straightening of lumbar lordosis.The signal intensity of vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild facet and ligamentum flavum degenerative and hypertrophic changes and unremarkable otherwise.L2-L3 demonstrate mild disc desiccation, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Although the degenerative changes are not significant at this level there is evidence of mild central spinal stenosis at this level which is believed to be at least partially secondary to congenitally small pedicles. No neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is severe central spinal stenosis which is disproportionate to degree of degenerative disease and is believed to be at least partially secondary to congenitally a small pedicle. No significant neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height, shallow broad-based disc protrusion extending from right paramedian to the left and far laterally on the left. Moderate bilateral ligamentum flavum hypertrophy is present. Mild facet disease without significant hypertrophic changes. Fluid signal intensity within bilateral articulating facets suspected for effusion or synovitis. Changes at this level results in significant central spinal stenosis, severe left neural foraminal compromise and mild to moderate on the right.L5-S1 demonstrates advanced disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophic changes. Mild central spinal stenosis and significant bilateral neural foraminal compromise (R>L) is noted.Examination also demonstrates fatty signal intensity of filum terminale extending from mid L3 level to mid L5. There is however normal termination of the cord at L1-L2 level the lower most visualized thoracic cord and conus demonstrate normal signal intensity.
1.Mild degenerative changes at L2-L3 with resultant central spinal stenosis.2.Moderate degenerative changes at L3-L4 with resultant central spinal stenosis.3.Advanced degenerative changes at L4/L5 and a left-sided broad-based disc protrusion results in significant central spinal stenosis.4.Advanced degenerative changes at L5/S1 results in mild central spinal stenosis.5.There is highly suspected congenitally short pedicle. Please review detailed report above.6.Neural foraminal compromise at L4/L5 and L5-S1 levels (some significantly) as detailed above.7.Thin fatty signal intensity of filum terminale extending from L3 to L5 however with normal termination of the cord at L1-L2 level.