Diagnosis: Lumbago with sciatica, right side Lumbago with sciatica, left sideClinical question: low back and leg painSigns and Symptoms: low back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height and disc desiccation as well as a diffuse disc bulge. There are some endplate reactive changes at this level which are high signal on T1 and low signal on T2 STIR. The fat at the lateral recess bilaterally and the fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with loss of disc space height and disc desiccation. There is mild ligamentum flavum hypertrophy at this level. The fat at the lateral recess bilaterally and the fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L3-4 there is a large central disc extrusion present which compresses the thecal sac and effaces spinal fluid surrounding the nerve roots creating a moderate degree of spinal stenosis. The fat at the right lateral recesses partially effaced at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is disc desiccation present associated loss of disc space height at T12-L1 and T11-T12 associated with a minor disc bulge at T11-T12.
There are multilevel degenerative changes present in the lumbar spine mainly in the form of disc disease. This is worse at L3-4 there is a moderate degree of spinal stenosis as a result of a central disc extrusion associated with encroachment of the right lateral recess more than the left lateral recess nerve roots.