Clinical question: 60-year-old with AML undergoing treatment with RT-chemotherapy with history of chronic back pain, now with worsening back pain after LP. Evaluate for causes of pain. Signs and symptoms: Significant back pain status post LP. Nonenhanced complete spine MRI:MRI of cervical spine demonstrate normal signal intensity and alignment of vertebral column. Unremarkable images through foramen magnum. No evidence of central spinal stenosis or neural foraminal compromise at any level. Unremarkable. Spinal soft tissues.Nonenhanced MRI of thoracic spine:Examination demonstrates normal signal intensity and alignment of vertebral column.There is normal signal intensity and caliber of thoracic cord.There is no evidence of a spinal stenosis or neural foraminal compromise at any level.No evidence of epidural or perispinal soft tissue abnormalities.Nonenhanced lumbar MRI:There is normal anatomical alignment and signal intensity of the vertebral column.No evidence of abnormal epidural widening or signal abnormality.Normal signal intensity of the lower most visualized thoracic spine, conus or the cauda equina.At L4-L5 there is mild disc disease and loss of disc height, extensive bilateral facet and ligamentum flavum hypertrophy and including right facet effusion. There is mild grade 1 anterolisthesis. There is a broad base central to far right lateral disc protrusion resulting in significant right neural foraminal and right lateral recess compromise. Mild central spinal stenosis and moderate to severe left neural foraminal compromise is also present.At L5-S1 mild disc disease and mild to moderate facet and ligamentum flavum hypertrophy is noted. Tiny right lateral annular fissure is present. No central spinal stenosis although moderate left neural foraminal compromise is detected.Mild increased T2 STIR signal in the soft tissues of lower back could represent changes from recent help ease.
1.Unremarkable nonenhanced MRI of cervical spine.2.Unremarkable nonenhanced thoracic MRI.3.Nonenhanced MRI of lumbar spine demonstrate degenerative changes at L4-L5 and including a right lateral and far lateral broad-based disc protrusion with significant right neural foraminal compromise and very mild central spinal stenosis. Degenerative changes of posterior elements at the L4-L5 and mild disc disease is also noted.