Clinical question: Assess for spinal stenosis. Signs and symptoms: Weakness with walking. Nonenhanced lumbar MRI:There is unremarkable signal intensity of the vertebral column and with normal anatomical alignment.Examination at T12-L1 through L3-L4 levels demonstrate mild degenerative changes however without spinal stenosis or neural foraminal compromise. Incidental note is made of a well demarcated CSF signal intensity in the left neural foramina at T11-T12 without evidence of neural foraminal widening. Finding is highly suggestive of a small Tarlov or perineural cyst of no clinical significance.L4-L5 demonstrate mild disc disease and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Mild bilateral facet space widening and effusion at this level is also noted. Constellation of changes results in significant central spinal stenosis as well as moderate to severe bilateral neural foraminal compromise.L5-S1 demonstrate mild disc desiccation and severe bilateral facet hypertrophy and including bilateral facet effusion and moderate ligamentum flavum hypertrophy. There is a right para median annular fissure. Mild central spinal stenosis and moderate bilateral (R>L) neural foraminal compromise is also detected.There are bilateral Tarlov cysts in the sacral spine.Unremarkable paraspinal soft tissues.
1.Degenerative changes at L4-L5 (more noticeably of the posterior elements) results in significant central spinal stenosis with bilateral neural foraminal compromise.2.Mild Central spinal stenosis at L5-S1 and with moderate bilateral neural foraminal compromise. There is a small right paramedian annular fissure at this level.3.Unremarkable images at all other