Clinical question: Assess for deterioration of lumbar radiculopathy/stenosis. Signs and symptoms: Back pain and radicular pain. Nonenhanced lumbar MRI:T11-T12 these unremarkable and unchanged since prior exam.T12-L1 demonstrate moderate degenerative disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is no spinal stenosis however mild right neural foraminal compromise is noted. Is progression of disease since prior study.L1-L2 demonstrate mild disc disease and loss of disc height, asymmetric mild right facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. No significant change since prior exam.L2-L3 demonstrates advanced disc disease and loss of disc height with evidence of progression since prior exam. There is asymmetric diffuse shallow bulging disc on the left and far laterally, asymmetric (L>R) moderate facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is significant left neural foraminal and left lateral recess compromise at this level and no central spinal stenosis in AP axis. Since prior exam there is interval significant decreased size of the large left lateral disc protrusion.L3-L4 demonstrate mild disc disease moderate bilateral (L>R) facet hypertrophic changes with resultant significant left neural foraminal compromise, no spinal stenosis and patent right neural foramen. There is interval progression of disease at this level and left neural foraminal compromise is a new finding. Also new since prior exam is mild chronic compression deformity of the superior endplate of L4.L4-L5 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum and facet hypertrophic changes and including widening of the facet spaces with fluid signal intensity (effusion). There is interval progression of degenerative changes at this level. Mild compromise of AP axis of the canal without convincing evidence of central spinal stenosis. There is moderate left lateral recess compromise and no significant neural foraminal compromise.L5/S1 demonstrate mild disc disease, large left lateral and far lateral disc protrusion in combination with asymmetric hypertrophic changes of posterior elements on the left results in significant left neural foraminal and left lateral recess compromise. No central spinal stenosis and patent to right neural foramina.
1.Degenerative changes of the discs and the posterior elements with evidence of mild interval progression since prior exam as detailed.2.No evidence of clinically significant central spinal stenosis at any level.3.There are however multilevel neural foraminal and lateral recess compromise secondary to degenerative disease and disc protrusions as detailed per level above.