Clinical question: Evaluate for evidence of herniated disc or spinal stenosis at L2-L3 area. Signs and symptoms: Radicular pain L2-L3 dermatomes and bilateral hip flexor weakness. Nonenhanced lumbar MRI:Examination demonstrates severe levoscoliosis of lumbar spine centered at L2 level. There is also significant dextroscoliosis of lower thoracic spine.The visualized lower thoracic spine from T9 inferiorly demonstrate mild degenerative changes however without evidence of spinal canal compromise or stenosis. The signal intensity and caliber of thoracic cord and conus remains within normal.T12-L1 demonstrate no spinal stenosis or neural foraminal compromise.L1-L2 demonstrate mild degenerative changes without central spinal stenosis or neural foraminal compromise.L2-L3 demonstrate asymmetric right-sided hypertrophic changes of posterior elements with subtle mass effect and deviation of the thecal sac to the left however without spinal stenosis or neural foraminal compromise.L3-L4 demonstrates asymmetric right-sided facet hypertrophic changes resulting in mild right neural foraminal compromise and no central spinal stenosis.L4-L5 demonstrate no spinal stenosis or neural foraminal compromise mild to moderate asymmetric right-sided facet and ligamentum flavum hypertrophy however is present.L5-S1 demonstrate no spinal stenosis or neural foraminal compromise.Unremarkable images through the sacral spine.
1.Severe levoscoliosis of lumbar spine and dextroscoliosis of thoracic spine is noted.2.There is no evidence of spinal stenosis at any level.3.There is no significant neural foraminal compromise at any level.4.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina and unremarkable paraspinal soft tissues.5.Mild to moderate asymmetric hypertrophic changes of posterior elements correlating with the scoliosis as detailed above.