Clinical question: Has disc herniation changed. Signs and symptoms: Left lower extremity progressive, preop, symptoms changed. Nonenhanced lumbar MRI:The alignment of the vertebral column remains anatomical and stable since prior study.Examination at T 11-T12 through L2-L3 levels is unremarkable.L3-L4 demonstrate mild disc disease and loss of disc signal and height, mild bilateral facet and ligamentum problem hypertrophy without central spinal stenosis or neural foraminal compromise. There is a right para median linear T2 hyperintensity within the annulus of the disc consistent with an annular fissure. This finding is more conspicuous (axial T2 series 6 image 21 and sagittal T2, T2 STIR image 8) on current exam compared to prior study which is suggestive of interval worsening.L4-L5 demonstrate moderate disc disease and loss of disc height and signal intensity and moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet disease however. Bilateral facet effusion fairly similar to prior study.Previously noted large central broad-based disc protrusion demonstrate interval increase in size and mass effect on the thecal sac and spinal stenosis. On axial T2 series 6 image 15 disc protrusion measures approximately 19 mm at the base and 7 mm in height both feet interval increase since prior study measurement of 15 x 4 mm. Moderate central spinal stenosis with interval worsening and no neural foraminal compromise.L5-S1 is unremarkable other than mild degenerative changes.
1.Interval increased size of a central L4-L5 disc protrusion with increased mass effect and moderate central spinal stenosis without neural foraminal compromise.2.No spinal stenosis or neural foraminal compromise at any other level.3.More conspicuous right paramedian annular fissure at L3-L4 since prior study.