Clinical question: Worsening back pain despite physical therapy. Signs and symptoms: Severe leg pain and numbness. Nonenhanced lumbar MRI:There is mild generalized narrowing of the spinal canal which is believed to be at least partially secondary to congenital anatomical variation of the short pedicles.T11 -- T12 demonstrates significant asymmetric left-sided ligamentum flavum hypertrophy which results in mass-effect and forward displacement of the cord and central spinal stenosis. Moderate to significant right neural foraminal compromise is also detected.On axial T2-weighted images (series 701 image 47 and 48) there is a suggestion of mild increased T2 signal intensity of the cord which could represent edema.T12 -- L1 demonstrate asymmetric right-sided ligamentum flavum hypertrophy and mild bilateral facet disease. There is significant right neural foraminal compromise, no central spinal stenosis and patent the left neural foramina.L1 -- L2 demonstrate moderate bilateral (right greater than left) ligamentum flavum hypertrophy and mild right facet hypertrophy. There is significant right neural foraminal compromise, no central spinal stenosis and patent the left neural foramina.L2 -- L3 demonstrate mild disk disease and loss of disk height, mild left and moderate right facet and ligamentum flavum hypertrophy. There is a linear T2 hyperintensity in the annulus of the disk laterally on the left consistent with an annular fissure. There is mild to moderate central spinal stenosis and moderate bilateral neural foraminal compromise. Incidental note at this level is a superficially located single locule left renal cyst.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy, mild degenerative facet disease and evidence of bilateral facet effusion. There is mild central spinal stenosis with mild to moderate bilateral neural foramina compromise.L4 -- L5 demonstrate mild degenerative disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is a left-sided far lateral annular fissure which is best appreciated on axial T2 series 701 image 17 and sagittal T2 severe on images 3 through 5.No spinal stenosis, however moderate bilateral neural foraminal compromise is present.L5 -- S1 demonstrate mild disc disease and loss of disk height, moderate bilateral facet hypertrophy and mild ligamentum flavum. No central spinal stenosis. Moderate (left greater than right) neural foraminal compromise is present.Unremarkable visualized SI joints.Unremarkable paraspinal soft tissues other than above mentioned left renal cyst.
1.Generalized mild narrowing of the spinal canal believed to represent a congenital anatomical variation of short pedicles.2.Degenerative changes of disks and posterior elements in combination with congenitally short pedicles results in multilevel central spinal stenosis most noticeably at L2- L3 and L3 -- 4 levels. 3.There are multi-level neuroforaminal compromise throughout the lumbar and lower most visualized thoracic spine as detailed per level above.4.Significant asymmetric ligamentum flavum hypertrophy on the left at T11 -- T12 with resultant central spinal stenosis and neural foraminal compromise as detailed. There is suspected subtle T2 hyperintensity of the cord at this level.5.Please review detailed report per level above.