Clinical question: Explanation for leg pain. Signs and symptoms: Left leg pain, numbness. Pre and post enhanced lumbar MRI:T10-T11, T11-T12, T12-L1, L1-L2 and L2-L3 levels demonstrate no spinal stenosis or neural foraminal compromise. Minimal hypertrophic changes of posterior elements are present.L3-L4 demonstrate moderate disc disease and loss of disc height, mild right facet and ligamentum flavum hypertrophy and left-sided prior laminectomy with resultant mild expansion of thecal sac. There is a central and left for small disc protrusion at this level which results in mild flattening of the thecal sac. No evidence of spinal stenosis or neural foraminal compromise. Expected mild posterior epidural thickening at the surgical site with enhancement is noted.L4-L5 demonstrate moderate disc disease and loss of disc height, central and leftward disc extrusion with evidence of inferior migration of disc fragment posterior to the body of L5 on the left. Finding results in significant left lateral recess compromise, moderate central spinal stenosis and patent bilateral neural foramina.L5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet hypertrophy and mild right ligamentum flavum hypertrophy is also noted. There is evidence of a prior left-sided laminectomy with resultant localized expansion of thecal sac posteriorly. There is widening of the appearance space along the left lateral aspect of the thecal sac along the surgical path with expected enhancement representing epidural scarring. The enhancement extends anteriorly and is inseparable from the left S1 nerve root. There is a shallow central and left paramedian broadbase disc protrusion at this level with subtle mass effect on the thecal sac. No convincing evidence of central spinal stenosis however mild decreased caliber of thecal sac from left sided epidural scarring is noted. Additionally note is made of a right-sided far lateral small disc protrusion resulting in moderate right neural foraminal and right lateral recess compromise.
1.L3-L4 demonstrate small central and leftward disc protrusion and evidence of a prior left-sided laminectomy without spinal stenosis.2.L4-L5 demonstrates a central and leftward disc herniation and with inferior migration of the disc fragment on the left which is often significant left lateral recess and moderate central spinal stenosis and without neural foraminal. There is evidence of left-sided laminectomy at this level also as detailed.3.L5-S1 demonstrate postoperative changes of left sided laminectomy with mild expansion of thecal sac. Left-sided epidural thickening and enhancement suggestive of epidural fibrosis/scarring. A central and left paramedian shallow disc protrusion with subtle mass effect on the thecal sac is noted. A right-sided far lateral shallow broad-based disc protrusion at this level with resultant moderate right neural foraminal and lateral recess compromise.