Diagnosis: Lumbago with sciatica, left sideClinical question: eval for lumbar spine pathologySigns and Symptoms: LBP and LLE pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. A small high signal focus is present within the L1 vertebral body measuring approximately 6 mm in diameter which is bright on T1 and T2 and suppresses on inversion recovery sequence. Most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is redemonstration of a broad-based left lateral recess and left lateral disk protrusion which effaces the fat at the left lateral recess and extends into the left neural foramen where it partially effaces the fat along the inferior aspect of the neural foramen. The exiting nerve root is surrounded by fat. There is also some ligamentum flavum hypertrophy present at this level. There is a small right lateral disk protrusion at this level which is also stable since the prior exam. It mildly narrows the right neural foramen. There is loss of disk space height and desiccation present at this level. Overall there is no substantial change since the prior exam at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and desiccation present at this level. There is a right lateral disk protrusion present at this level which partially effaces fat along the lower aspect of the neural foramen and partially effaces fat at the right lateral recess. The exiting nerve root is surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and desiccation present at this level. At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of a small cystic lesion along the right kidney probably representing cortical cyst it has not changed since the prior exam.
There are degenerative changes present in the lumbar spine worse at L4-5 where there is a broad-based left lateral recess disk protrusion which encroaches on the right the left lateral recess (probably left L5 nerve root). This is stable since the prior exam. There is also some milder encroachment of the nerve root at the right lateral recess at L3-4 due to disk protrusion which is also unchanged.