Clinical question: Low back pain L5. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI: There is normal anatomical alignment of vertebral column.The signal intensity of the vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate no appreciable disc disease however moderate bilateral ligamentum flavum hypertrophy and mild (left greater than right) facet hypertrophic changes are present. Findings results in moderate central spinal stenosis however without neural foraminal compromise.L3-L4 demonstrate mild disc disease and loss of disc height, post operative changes of right laminectomy and resultant expansion of thecal sac without central spinal stenosis. No neural foraminal compromise is noted.L4-L5 demonstrate moderate disc disease and loss of disc height, significant bilateral ligamentum flavum hypertrophy, significant bilateral facet hypertrophic changes and including bilateral facet space widening and effusion. Constellation of findings results in significant central spinal stenosis and moderate to severe bilateral neural foraminal compromise. There is finding suggestive of prior bony fusion posteriorly at this level.L5-S1 demonstrate mild disc disease, without spinal stenosis however with moderate bilateral neural foraminal compromise. There is extensive bone formation contiguous with the articulating facets at this level suggestive of prior bony fusion.
1.Extensive hypertrophic changes of the ligamentum flavum at L2-L3 with resultant moderate central spinal stenosis without neural foraminal compromise.2.Postoperative changes of right laminectomy at L3-L4 without spinal stenosis and no neural foraminal compromise.3.Extensive degenerative changes at L4-L5 including facet effusion results in significant central spinal stenosis and moderate bilateral neural foraminal compromise.4.There is evidence of prior posterior bony fusion at L4-L5 and L5-S1 levels.