Clinical question: Back pain radiating to both legs, numbness, weakness, please evaluate for cord compression. Signs and symptoms cord low back pain radiating to both legs and weakness. Nonenhanced total spine MRI:Examination demonstrate normal signal intensity and alignment the vertebral column.There is normal signal intensity and caliber of cervical, thoracic cord and conus without evidence of mass effect.Examination at L4 -- L5 demonstrate moderate degenerative disk disease, loss of disk height and a large disk extrusion with resultant moderate to severe central spinal stenosis. Unremarkable images through the lumbar spine otherwise.The finding in the lumbar spine will be followed with a pre-and post enhanced lumbar MRI for further assessment.Unenhanced lumbar MRI:The examination was terminated by patient after acquisition of a sagittal T2 and axial T2-weighted series of the lumbosacral spine.Examination demonstrate moderate disk disease and loss of disk height at L4 -- L5 level and mild to moderate bilateral ligamentum flavum hypertrophy. In addition there is a large central and rightward disk extrusion with mild superior migration behind the vertebral body of L4 in the right paramedian location. Above changes results in significant central spinal stenosis and moderate right neural foraminal compromise.Examination at T12 -- L1 through L3 -- 4 and at L5 -- S1 levels are unremarkable.Findings and concern on this exam were discussed with the ED staff DR, Cosban Travispager # 2678 at the time of review of exam.
1.Nonenhanced total spine MRI demonstrate normal signal intensity and caliber of the cord and conus without mass effect. No detectable degenerative changes of the spine, no detectable abnormality and no detectable spinal canal or neural foraminal compromise.2.Limited nonenhanced MRI of the lumber spine demonstrate a large central and rightward disk extrusion with partial superior migration behind the body of L4 and right paramedian location. This finding in addition the degenerative changes results in significant central spinal stenosis and moderate right neural foraminal compromise.