Critical question: Evaluate for spinal cord/nerve root impingement given lumbar disk disease and worsening of symptoms. Signs and symptoms: Left leg weakness. Nonenhanced lumbar MRI:T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild hypertrophic changes of the ligamentum flavum and unremarkable otherwise.L2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. Widening of the left fossa the space containing fluid signal intensity suggestive of inflammatory change or synovitis. No spinal stenosis however mild bilateral neural foraminal compromise is present.L4 -- L5 demonstrate moderate disk disease and loss of disk height, extensive hypertrophic changes of articulating facets and to a lesser degree of the ligamentum flavum. Constellation of changes result in grade 1 antral listhesis however without spinal stenosis. Mild bilateral neural foraminal compromise is present. There is increased T2 signal intensity within the annulus of the disk on the left (sagittal T2/T2 stir images 6 through 9) and consistent with an annular fissure.L5 -- S1 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis however mild bilateral (left greater than right) neural foraminal compromise are present.
1.Moderate changes at the L4 -- L5 with resultant grade 1 anterolisthesis however without central spinal stenosis is noted. There is evidence of an annular fissure at this level as detailed.2.Moderate changes at L5 -- S1 without spinal stenosis.3.Unremarkable exam at the other levels.