Clinical question: Evaluate for HNP. Signs and symptoms: Low back pain radiating down left leg with DF plus PF thickness. Nonenhanced lumbar MRI:The alignment of vertebral column remains anatomical.The signal intensity of the vertebral column is unremarkable other than changes related to degenerative disease.Unremarkable lower most visualized thoracic spine and thoracic cord.T12-L1 demonstrate minimal degenerative disease without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate mild disc disease without spinal stenosis or neural foraminal compromise.L2-L3 is unremarkable.L3-L4 is unremarkable other than mild degenerative changes.L4-L5 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum degenerative changes including minimal bilateral facet effusion. There is a large left-sided disc extrusion with significant mass effect and posterior displacement of left S1 nerve root in the left lateral recess, subtle mass effect on the thecal sac without central spinal stenosis. There is also subtle mass effect by the herniated disc on the right S1 nerve root.
1.At L5-S1 there is a large left-sided disc extrusion with resultant significant mass effect on the left lateral recess and left S1 nerve root and minimal mass effect on the right S1 nerve root. No spinal stenosis or appreciable neural foraminal compromise.2.Mild degenerative changes at other levels however without spinal stenosis or neural foraminal compromise as detailed per level above.3.Unremarkable lower most visualized thoracic spine and thoracic cord.