Clinical question: Rule out herniated disc. Signs and symptoms: Back pain with radiculopathy. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.The signal intensity of the vertebral column is unremarkable.The lower most visualized thoracic spine and thoracic cord is unremarkable other than minimal degenerative disease.T12-L1 and L2-L3 levels are unremarkableL2-L3 demonstrate mild disc desiccation and mild facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. No significant change since prior.L3-L4 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophy changes including minimal facet effusion without significant change since prior exam. There is however interval resolution of previously noted small disc protrusion on the right since prior study. There is no central spinal stenosis however moderate right neural foraminal compromise secondary to degenerative disease is detected. The left neural foraminal remains patent.L4-L5 demonstrate mild to moderate disc disease and loss of disc height, moderate bilateral (L>R) facet degenerative and hypertrophic changes with interval progression since prior exam. No convincing evidence of central spinal stenosis, however mild compromise of the transverse diameter of the spinal canal secondary to ligamentous hypertrophic changes is noted. Additionally at this level note is made of an extruded disc fragment migrating superiorly posterior to the body of L4 vertebrae on the left (sagittal T2, T2 STIR images 13 and 14 and axial T2 series 6 images 25 through 27). The finding results in mass effect and posterior displacement of the thecal sac on the left and significant left lateral recess compromise. There is also significant left neural foraminal compromise secondary to degenerative disease. Mild to moderate right neural foraminal compromise as a result of degenerative disease is also noted.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. No central spinal stenosis or neural foraminal compromise. There is a small immediate right paramedian annular fissure which is best appreciated on axial T2 series 6 image 34 and sagittal T2 STIR image 9.
1.At L4-L5 examination demonstrate an extruded disc fragment on the left migrating superiorly behind the vertebral body of L4 which in combination with degenerative changes results in significant left neural foraminal and left lateral recess compromise without convincing evidence of central spinal stenosis.2.At L3-L4 level there is interval resolution of a previously noted right sided disc protrusion. Degenerative changes however results in significant right neural foraminal compromise.3.Degenerative changes at other levels with mild progression since prior study however without spinal stenosis or neural foraminal compromise.4.Lower most visualized thoracic spine and thoracic cord is unremarkable with the exception of mild degenerative disease. Please review above detailed report per level.5.