Clinical question: Evaluate for etiology of left-sided lumbar radiculopathy. Signs and symptoms: Left lumbosacral radiculopathy. Pre-and post-enhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.There is unremarkable signal intensity of the vertebral column other than changes related to degenerative disease.Unremarkable normal visualized thoracic spine and cord from T11 inferior.T11 -- T12 and T12 -- L1 levels are unremarkable.L1 -- L2 demonstrate mild disk disease with subtle loss of disk height and no significant degenerative changes posterior elements. No spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk desiccation and mild facet/ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk desiccation and mild (right greater than left) facet/ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L4 -- 5 demonstrate moderate disk disease and mild loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet disease. There is a central and right paramedian broad based disk protrusion and small spur. Finding causes posterior displacement of thecal sac and mild central spinal stenosis and bilateral neural foraminal compromise. Post-enhanced images demonstrate expected enhancement of disk protrusion at this level.L5 -- S1 demonstrate mild to moderate disk disease and mild to moderate right facet and ligamentum flavum hypertrophy. No central spinal stenosis. There is however moderate right neural foraminal compromise secondary to asymmetric right facet hypertrophy.Post-enhanced images demonstrate expected subtle enhancement of degenerative changes of posterior elements and above-mentioned disk protrusion. No evidence of abnormal enhancement the lower most visualized cord, conus or cauda equina.
1.Degenerative changes and L4 -- L5, central and rightward broad based disk protrusion and a bony spur results in mild central spinal stenosis and bilateral neural foraminal compromise.2.Degenerative changes at other levels however without central spinal stenosis and only moderate right neural foraminal compromise at L5--S1 level.3.Unremarkable post enhanced images other than expected enhancement of the hypertrophic changes of the posterior elements and disk protrusion at L4 -- L5.