Clinical question: Left lumbar radicular pain for 6 months. Signs and symptoms: As above. Nonenhanced lumbar MRI:The signal intensity of the vertebral column is unremarkable.The anatomical alignment of vertebral column is preserved.Lower most visualized thoracic spine and cord is unremarkable.T12-L1, L1-L2, L2-L3 levels are unremarkable.L3-L4 demonstrate mild disease and mild bilateral facet and ligamentum flavum hypertrophy without neural foraminal compromise or convincing evidence of central spinal stenosis.L4-L5 demonstrate mild to moderate left and mild right facet and ligamentum flavum hypertrophy and mild facet disease. There is a shallow right lateral disc protrusion with slight extension into the right lateral recess (axial T2 series 5 image 18 and sagittal T2 and T2 STIR images 6 through 8). This finding results in mass effect on the right lateral recess and right L5 nerve root. No spinal stenosis or significant neural foraminal compromise. No spinal stenosis and mild left neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and loss of disc height, mild to moderate bilateral facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is a broad-based central disc protrusion at this level which is in contact and slightly displaces the left S1 nerve root in the left lateral recess. No spinal stenosis or neural foraminal compromise.Unremarkable perispinal soft tissues.
1.Mild to moderate degenerative changes at L5-S1 and a central broad-based disc protrusion with subtle mass effect on the left lateral recess and left S1 nerve root.2.Shallow small right lateral disc protrusion at L4-L5 with resultant mass effect on the right lateral recess and right L5 nerve root.3.No central spinal stenosis or significant neural foraminal compromise at any level.