Clinical question: Compared to x-ray of the lumbar spine. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:At T12-L1 there is a T2 hypointense left lateral epidural defect (sagittal T2 image 7 and axial T2 series 601 images 38 through 40) finding extends into the left neural foraminal at T12-L1 level and is suspected of an extruded disc fragment. There is resultant moderate left neural foraminal compromise and no central spinal stenosis.L1-L2 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.L2-L3 demonstrates advanced disc disease with loss of disc height, grade 1 retrolisthesis, mild bilateral facet (right greater than left) and ligamentum flavum hypertrophy with resultant moderate right neural foraminal compromise and moderate central spinal stenosis.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral (right greater than left) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is resultant moderate central spinal stenosis with moderate to severe right neural foraminal compromise and mild left.L4-L5 demonstrate mild disc disease and minimal loss of disc height, significant bilateral facet hypertrophic changes (right greater than left) and moderate bilateral ligamentum flavum hypertrophy. No central spinal stenosis however bilateral moderate neural foraminal compromise is present.L5-S1 demonstrate moderate disc disease and loss of disc height however the extensive (left greater than right) facet hypertrophic changes and to a lesser degree of the ligamentum flavum. No central spinal stenosis however severe bilateral neural foraminal compromise is present.No detectable signal abnormality of cauda equina or the conus, lower thoracic cord.Small bilateral renal cysts are identified.
1.Extensive degenerative changes of lumbar spine in particular hypertrophic changes of posterior elements are present.2.There is moderate central spinal stenosis at L2-L3 and L3-L4 levels.3.There is an extruded disc fragment posterior to the vertebral body of T12 and extending into the left T12-L1 neural foramina with resultant moderate compromise and no central spinal stenosis.4.Multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above.