Right sciatica. Rule out disc disease. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The cord signal intensity is within normal limits. The conus medullaris on sagittal imaging is grossly intact. There are mild degenerative changes of the visualized lower thoracic spine.T12-L1 through L3-4: Mild degenerative changes are noted but there is no significant compromise to spinal canal or neural foramina.L4-5: There is a large broad based disc protrusion across the ventral thecal sac greater on the right as well as mild facet degenerative changes and severe ligamentum flavum hypertrophy. These constellation of findings causes moderate to severe central spinal canal stenosis and severe right neural foraminal stenosis as well as severe right lateral recess compromise. There is also mild to moderate left neuroforaminal stenosis. Increased STIR signal within the L4-5 disc as well as the adjacent endplates are noted greater along the inferior endplate. Given the abnormal signal intensity within the disc, follow-up MRI with contrast is recommended to rule out discitis.L5-S1: Mild degenerative disease and moderate facet degenerative changes but no significant compromise to spinal canal or neural foramina. A small synovial cyst is noted projecting posteriorly from the right articular facet measuring 6 x 9 mm.Note is made of severe renal atrophy.
1.Large broad base disc protrusion at the L4-5 level, facet degenerative changes and advanced ligamentum flavum hypertrophy causes moderate to severe central canal stenosis, severe right neuroforaminal and right lateral recess compromise.2.Increased T2/STIR intensity within the L4-5 disc as well as within the adjacent vertebral body endplates is likely degenerative but follow-up contrast MRI imaging is recommended to rule out the possibility of discitis.