Clinical question: Follow-up lumbar spinal stenosis. Signs and symptoms: Pain and tingling. Nonenhanced lumbar MRI:T10-T11, T11-T12, T12-L1 levels are unremarkable other than mild degenerative changes.L1-L2 demonstrate moderate disc disease and loss of disc height, mild broad-based bulging disc, asymmetric (R>L) ligamentum flavum hypertrophic changes and mild facet disease. There is interval progression of degenerative disease at this level since prior exam. Constellation of changes results in mild central spinal stenosis and moderate to severe right lateral recess compromise. Linear increased T2 signal intensity within the annulus of the disc on the left and far laterally consistent with an annular fissure is noted. There is highly suspected early development of a right sided synovial cyst dissecting into the right ligament and contributing to right lateral recess compromise. No neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and moderate bilateral facet hypertrophic changes. There is interval progression of disease and resultant moderate to severe central spinal stenosis and mild left neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height and moderate bilateral facet and ligamentum flavum hypertrophy and including the right facet effusion. There is progression of disease since prior exam. New since prior exam however is a large left sided disc extrusion with superior migration behind the vertebral body of L3 on the left. There is resultant significant mass effect on the thecal sac on the left and the deviation to the right as well as significant central spinal stenosis. Moderate left neural foraminal compromise and patent right.L4-L5 demonstrate mild disc disease and loss of disc height, severe left and mild right facet and ligamentum flavum hypertrophic changes are present. There is progression of degenerative changes since prior exam. There is central shallow broad-based disc protrusion at this level which is new since prior exam and with resultant subtle flattening deformity of the thecal sac. There is mild central spinal stenosis, significant left lateral recess compromise, significant left neural foraminal compromise and patent right neural foramen.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. Without significant change since prior exam. There is no neural foraminal or central spinal stenosis.
1.At L3-L4 there is a large left-sided disc extrusion with superior migration behind the body of L3 which in combination with extensive degenerative changes results in significant central spinal stenosis and moderate left neural foraminal compromise as detailed. There is progression of degenerative changes at this level.2.Interval progression of degenerative disease at L1-L2 with resultant significant right lateral recess compromise as detailed.3.Please review progression of degenerative disease at other levels as detailed per level above.