Clinical question: Lumbar stenosis and L4 -- 5. Signs and symptoms: Bilateral leg pain right worse than left. Nonenhanced lumbar MRI:T11 -- T12 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T12 -- L1 demonstrate mild degenerative changes without spinal stenosis or neural foramina compromise. A well-demarcated focus of T1 and T2 hyperintensity within the vertebral body of L1 consistent with a hemangioma with no clinical significance.L1 -- L2 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate a very large central and left sided disk extrusion result in significant central spinal stenosis however on neural foraminal compromise. Moderate disk disease and moderate to severe bilateral facet and ligamentum flavum hypertrophy contributes to spinal stenosis at this level as well. L5 -- S1 demonstrate mild disk disease with moderate facet and mild ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. Hypertrophic changes of the right ligamentum flavum however results in mild right lateral recess compromise.
1.Large central and leftward disk extrusion and extensive hypertrophic changes of posterior elements at L4 -- L5 results in significant central spinal stenosis as detailed. No neural foraminal compromise.2.Mild to moderate degenerative changes at other levels however without central spinal stenosis or neural foraminal compromise.3.Mild right lateral recess compromise at L5 -- S1 secondary to right-sided ligamentum flavum hypertrophy.