Clinical question: Assess lumbar spine for possible stenosis, disc pathology, foraminal stenosis, cause of symptoms of the spinal stenosis. Signs and symptoms: Bilateral buttock to knee pain, worse with standing. Nonenhanced lumbar MRI:The signal intensity of vertebral column is unremarkable and the anatomic alignment is within normal.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild degenerative changes and unremarkable otherwise. Incidental note is made of multiple bilateral large renal cysts which are partially visualized. Recommend follow-up with dedicated imaging.L3-L4 demonstrate moderate disc disease and loss of disc height, mild broad base bulging disc and mild ligamentum flavum hypertrophy. No spinal stenosis however mild bilateral neural foraminal compromise is noted.L4-L5 demonstrate mild disc disease and loss of disc height, moderate asymmetric right-sided facet hypertrophic changes and mild facet and ligamentum flavum hypertrophy on the left. There is no spinal stenosis however moderate the right and mild left neural foraminal compromise are present.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral hypertrophic changes of posterior elements. No spinal stenosis or neural foraminal compromise. Examination at this level however demonstrate a linear increased T2/T2 STIR signal intensity within the annulus of the disc in the midline and bilateral paramedian consistent with an annular fissure which is best appreciated on axial T2 series 5 image 22 and sagittal T2, T2 STIR image 10.
1.Mild to moderate degenerative changes of lumbar spine without spinal canal compromise or stenosis at any level.2.Midline and bilateral paramedian annular fissure at L5-S1 is noted.3.Mild to moderate neural foraminal compromise as detailed per level above.4.Bilateral multiple large renal cysts are identified. Follow-up with dedicated imaging is recommended.