Clinical question: Patient with worsening sciatica and radiculopathy with lower extremity weakness. Signs and symptoms: As above. Nonenhanced lumbar MRI:T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable. Incidental note is 12 x 12 mm focus of T1 and T2 hyperintense and the L2 vertebral body posteriorly consistent with a benign skeletal capillary hemangioma.L2-L3 demonstrate mild disc desiccation and loss of disc height, shallow broad-based disc protrusion laterally and far laterally on the left is noted. There is also mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Mild left neural foraminal compromise and mild central spinal stenosis is present.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophy changes (right greater than left). There is also mild grade 1 anterolisthesis at this level secondary to degenerative disease. There is resultant moderate central spinal stenosis with significant right and mild left neural foraminal compromise.L4-L5 demonstrate moderate disc disease with mild loss of disc height, moderate (left greater than right) ligamentum flavum hypertrophy and moderate right and mild left facet hypertrophic changes. Degenerative changes at this level also includes mild grade 1 anterolisthesis. There is no central spinal stenosis however moderate right neural foraminal compromise and mild on the left is noted. There is also slight compromise of the left lateral recess present.L5-S1 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy is present. Moderate right facet disease and including facet effusion is noted. There is no central spinal stenosis however moderate left neural foraminal compromise is noted.Perispinal soft tissues are unremarkable.
1.Mild to moderate degenerative changes of the lumbar spine with resultant central spinal stenosis only at L3-L4 level of moderate degree as detailed.2.Multilevel mild-to-moderate neural foraminal compromise as detailed per level above.3.Unremarkable lower most visualized thoracic spine and thoracic cord.