Clinical question: 82-year-old patient with long-standing pain, rule out degenerative disease or fracture. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:The anatomical alignment of vertebral column is unremarkable. The signal intensity of the vertebral column demonstrate diffuse abnormality consistent with degenerative disease.Unremarkable lower most visualized thoracic spine and thoracic cord from T10 inferiorly.T11-T12 and T12-L1 levels are unremarkable.L1-L2 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophy changes. There is a far lateral right-sided broad-based disc protrusion with resultant moderate right neural foraminal compromise. Degenerative changes also results in moderate central spinal stenosis and mild left neural foraminal compromise.L2-L3 demonstrates advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum and to a lesser degree of bilateral facet hypertrophic changes. Constellation of changes results in moderate central spinal stenosis and moderate bilateral (left greater than right) neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease (left greater than right). Constellation of changes results in moderate central spinal stenosis and significant bilateral neural foraminal compromise.L4-L5 demonstrate moderate to advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy, moderate left facet degenerative changes and hypertrophy and to a lesser degree of the right facet. Constellation of changes results in mild to moderate central spinal stenosis, significant bilateral neural foraminal compromise and bilateral recess compromise (right greater than left).L5-S1 demonstrate mild disc disease and loss of disc height, shallow broad-based disc protrusion in the midline and extending to the right, mild bilateral ligamentum flavum hypertrophy, moderate to severe left and mild right facet degenerative/hypertrophic changes. There is evidence of a synovial cyst projecting posterior to the left articulating facet at this level measuring approximately 9 x 14 mm in transaxial dimensions (axial T2 series 601 image 13). Degenerative changes at this level results in mild central spinal stenosis and moderate right neural foraminal compromise.There is spinal soft tissues are unremarkable.
1.Extensive degenerative changes of lumbar spine results in multilevel central spinal stenosis of varying degrees at L1-L2 through L5-S1 levels as detailed by level.2.Degenerative changes also results in multilevel bilateral neural foraminal compromise (some significantly) as detailed per level.3.Right lateral disc protrusion at L1-L2 with resultant moderate right neural foraminal compromise is also noted.4.Hypertrophic changes of the left articulating facet at L5-S1 and a synovial cyst measuring at 9 x 14 mm projecting posterior to the left facets is present.