Clinical question: History of LBP and radiating leg pain. Unresolved pain medication. Signs and symptoms: Elevated BP, buttocks and leg pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.The signal intensity of the vertebral column is unremarkable.Lower most visualized thoracic spine and thoracic cord is unremarkable. T12-L1 is unremarkable.There is generalized uniform smaller than expected size of the spinal canal which is believed to represent a congenital anatomical variation.L1-L2 is unremarkable.L2-3 is unremarkable.L3-L4 demonstrate mild disc desiccation and a mild ligamentum flavum and facet degenerative changes. There is a small shallow central and left paramedian disc protrusion at this level (axial T2 series 5 image 14) results in subtle flattening and posterior displacement of the thecal sac which in combination with congenitally small canal results in mild central spinal stenosis however without neural foraminal compromise.L4-L5 is unremarkable.L5-S1 demonstrate moderate disc desiccation and loss of disc height, there is a shallow broad-based disc protrusion in the midline and to the right at this level. Finding results in significant mass effect and effacement of right lateral recess and mass effect on the right S1 nerve root. No central spinal stenosis or neural foraminal compromise (finding has best appreciated on axial T2 series 5 image 24 and sagittal T2 series 3 image 8).There is no detectable abnormality of the perispinal soft tissues.
1.There is a uniformly smaller size of spinal canal representing congenital anatomical variation of short pedicle.2.Large right side disc protrusion at L5-S1 with significant mass effect on the right lateral recess and right S1 nerve root as detailed. No neural foraminal or central spinal stenosis.3.Tiny central and rightward shallow disc protrusion at L3-L4 with subtle mass effect on the thecal sac which in combination with congenitally small canal results in mild central spinal stenosis.4.Unremarkable images at other levels and lower most visualized thoracic spine and thoracic cord.