Clinical question: Lumbar stenosis. Signs and symptoms: Low back pain, leg pain, difficulty ambulating because of severe pain. Nonenhanced lumbar MRI:T12/L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate moderate disc disease and loss of disc height, shallow broad-based bulging disc, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of findings results in moderate central spinal stenosis and mild bilateral neural foraminal compromise. No significant change since prior exam.L2-L3 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophy. Constellation of changes results in moderate to severe central spinal stenosis without significant change since prior exam. Mild bilateral (right greater than left) neural foraminal compromise is also noted.L3-L4 demonstrate moderate disc disease, loss of disc height, moderate to severe bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. Constellation of changes results in significant central spinal stenosis and moderate to severe right neural foraminal and moderate left neural foraminal compromise. No significant change since prior exam.L4-L5 demonstrate moderate disc disease and loss of disc height, broad-based bulging disc, mild grade 1 anterolisthesis, significant bilateral ligamentum flavum hypertrophy and mild bilateral facet disease and hypertrophy. There is resultant significant central spinal stenosis with mild interval progression secondary to progression of ligamentum flavum hypertrophy since prior exam. Significant right and moderate left neural foraminal compromise is also noted.L5-S1 demonstrate advanced disc disease with loss of disc height, shallow broad-based bulging disc, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis however moderate left and moderate to severe right neural foraminal compromise and lateral recess compromise bilaterally. No significant change since prior exam.
1.Extensive degenerative disc disease and hypertrophic changes of posterior elements of the lumbar spine results in multilevel central spinal stenosis of mild degree at L1-L2 and moderate stenosis at L2-L3 and moderate to severe at L3-L4 and L4-L5 levels (interval progression at the L4-L5 since prior exam) as detailed above.2.Multilevel bilateral neural foraminal compromise without significant change since prior exam as detailed per level above.