Clinical question: Evaluate for structural cause for radiculopathy. Signs and symptoms: S1 radiculopathy per EMG. Nonenhanced lumbar MRI:The signal intensity of vertebral column is unremarkable other than changes secondary to degenerative disease.Lower most visualized thoracic spine and thoracic cord from mid T10 inferiorly are unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Mild central spinal stenosis and moderate right neural foraminal compromise is noted.L3-L4 demonstrate mild disc desiccation, mild bilateral ligamentum flavum hypertrophy as well as mild bilateral facet hypertrophic changes (right greater than left). No convincing evidence of central spinal stenosis or clinically significant neural foraminal compromise.L4-L5 demonstrate moderate disc disease with loss of disc height, mild grade 1 retrolisthesis, significant and lateral facet hypertrophic changes and mild to moderate ligamentum flavum hypertrophy. Constellation of changes results in significant central spinal stenosis in transverse axis and moderate in AP axis. Significant bilateral (left greater than right) neural foraminal and lateral recess compromise is also present.L5-S1 demonstrate mild disc disease and significant right and moderate left facet hypertrophic changes and mild ligamentum flavum hypertrophy. No spinal stenosis, neural foraminal compromise or lateral recess compromise.
1.At L4-L5 extensive degenerative changes results in central spinal stenosis, significant bilateral neural foraminal and lateral recess compromise.2.At L2-L3 degenerative changes results in mild central spinal stenosis and moderate right neural foraminal compromise.3.No spinal stenosis or significant neural foraminal compromise at any other level however degenerative changes are present as detailed per level above.4.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina.