Clinical question: Evaluate for chronic lumbar spine pain. Signs and symptoms: Chronic back pain. Nonenhanced lumbar MRI:Lower most visualized thoracic spine the thoracic cord is unremarkable.T2 of ventricle and one demonstrate mild degenerative disk disease and unremarkable otherwise. Incidental note is made of a small skeletal capillary hemangioma of T12 vertebrae.L1 -- L2 demonstrate minimal degenerative changes and unremarkable otherwise.L2 -- L3 demonstrate mild degenerative changes of the disk and mild ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. Incidental note is made of a skeletal capillary hemangiomas of L3 vertebrae.L3 -- L4 demonstrate mild disk desiccation and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease and loss of disk height, significant (left greater than right) facet and ligamentum flavum hypertrophy, right facet space widening and effusion and mild grade 1 anterolisthesis. Constellation of above findings result since the thickened central spinal stenosis and bilateral neural foraminal compromise (right greater than left).L5 -- S demonstrate moderate disk desiccation and loss of disk height, shallow broad-based bulging disk and mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is no spinal stenosis however significant(bilateral left > right ) neural foraminal compromise is noted. There is disk osteophyte complex on the right with resultant significant right lateral recess compromise.
1.Extensive degenerative changes at L4 -- 5 and including grade 1 anterolisthesis results in significant central spinal stenosis and bilateral neural foraminal compromise as detailed above.2.Extensive degenerative disk disease at L5 -- S1 without central spinal stenosis however significant left and to lesser degree right neural foraminal compromise. Right-sided disk osteophyte complex also results in right lateral recess compromise.3.The right kidney is not identified on this exam and the left kidney is grossly unremarkable. Recommend correlation with dedicated images.