Diagnosis: SciaticaClinical question: eval for spinal stenosisSigns and Symptoms: radicular pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine associated with rotatory scoliosis. There is a perineural cyst in the sacral spinal canal.At L5-S1 there is loss of disk space height, disk dessication, diffuse disk bulge, endplate reactive change and facet and ligamentum flavum hypertrophy (left more than right). There is effacement of the fat at the left lateral recess and encroachment of the left exiting nerve roots at this level.At L4-5 there is loss of disk space height, disk dessication, diffuse disk bulge, endplate reactive change and facet and ligamentum flavum hypertrophy (left more than right). There is effacement of the fat at the lateral recess bilaterally and moderate spinal stenosis at this level with some mild encroachment of the exiting nerve roots bilaterally at this level.At L3-4 there is no significant compromise to the spinal canal. There is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with mild facet and ligamentum flavum hypertrophy. There is encroachment of the right exiting nerve roots at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with mild facet and ligamentum flavum hypertrophy. At L1-2 there is no significant compromise to spinal canal. There is a small broad based left paramedian and left lateral disk protrusion at this level extending into the left neural foramen and encroaching the left exiting nerve roots.
1.Multilevel degenerative changes are present associated with moderate spinal stenosis at L4-5 and neural foramen encroachment of exiting nerve roots as detailed above.2.There is a rotatory scoliosis and levocurvature most likely related to degenerative changes.