Clinical question: Reevaluate L4-L5 disc herniation; increased symptoms. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is unremarkable signal intensity of vertebral column other than changes related to mild degenerative disease.Examination at T12-L1 through L3-L4 levels are unremarkable and without interval change since prior exam.L4-L5 demonstrate mild disc desiccation and decreased disc height and mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is interval significant decreased size of a previously noted large herniated disc at this level. On current exam there is a T2 and T2 STIR linear hyperintensity along the undersurface of the disc in the midline and in bilateral paramedian (axial T2 series 601 image 8 and sagittal T2, T2 STIR image 9). Finding is consistent with an annular fissure. There is a tiny left lateral disc protrusion resulting in mild left lateral recess compromise.Mild broad-based bulging disc at this level without resultant central spinal stenosis. Mild compromise of lateral recess on the right however is noted.L5-S1 is unremarkable.
1.Interval complete resolution of large herniated disc at L4-L5 since prior exam.2.At L4-L5 there is a midline annular fissure which is new since prior exam. A tiny left lateral disc protrusion at this level with resultant left lateral recess compromise. Mild right lateral recess compromise secondary to degenerative changes and no evidence of central spinal stenosis.3.Unremarkable exam at other levels and without evidence of spinal stenosis or neural foraminal compromise.