Clinical question: Lumbar spinal stenosis. Signs and symptoms: Pain. Nonenhanced lumbar MRI:Lowermost visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 demonstrate mild degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes and unremarkable otherwise. L2 -- L3 demonstrate moderate disk disease and loss of disk height, shadow diffuse bulging disk, mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is no evidence of spinal stenosis however moderate left neural foraminal compromise is present.L3 -- L4 demonstrate mild to moderate disk disease and loss of disk height, moderate left and mild right ligamentum flavum hypertrophy and minimal facet disease. There is a tiny left lateral disk protrusion at this level which projects into the inferior aspect of the left neural foramina. Degenerative changes on the left results in mild neural foraminal compromise and patent right and central spinal stenosis.L4 -- L5 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Moderate right neuroforaminal compromise is sagittal images.L5 -- S1 demonstrate moderate disk disease with loss of disk height, moderate right and mild left ligamentum flavum hypertrophy, moderate bilateral (right greater than left) facet hypertrophic changes are noted. Constellation of the above findings results in mild grade 1 anterolisthesis however no convincing evidence of central spinal stenosis. There is moderate left lateral recess and left neural foraminal compromise . There is a suspected small synovial cyst on the right projecting anterior to the right ligamentum flavum.
1.No convincing evidence of a spinal stenosis at any level.2.Extensive degenerative changes at L5 -- S1 level with resultant mild grade 1 anterolisthesis and moderate left neural foraminal and lateral recess compromise.3.Mild to moderate degenerative changes at other levels however without central spinal stenosis.4.Neural foraminal compromise as detailed level above.