Clinical question: Evaluate for herniated disc. Signs and symptoms: Right lumbar pain. Nonenhanced lumbar MRI:Unremarkable lower most visualized thoracic spine and cord from T11 inferiorly.T12-L1, L1-L2, L2-L3 levels are unremarkable.L3-L4 demonstrate mild ligamentum flavum hypertrophy and minimal facet disease without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc desiccation with loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a central and rightward broad base disc protrusion with resultant mass effect and posterior displacement of the thecal sac causing mild central spinal stenosis. There is also significant right and mild left lateral recess compromise without neural foraminal compromise.5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral ligamentum flavum and mild facet hypertrophic changes. There is a right lateral disc extrusion resulting in significant right lateral recess compromise and mass effect on the right S1 nerve root (axial T2 series 7 image 44). No spinal stenosis or neural foraminal compromise.The alignment of vertebral column remains within normal and no detectable perispinal soft tissue abnormalities.
1.L5-S1 demonstrate degenerative changes as well as a right lateral disc extrusion with resultant mass effect on the right lateral recess without spinal stenosis or neural foraminal compromise.2.L4-L5 demonstrates degenerative changes and a broad-based central and rightward disc protrusion resulting in mild central spinal stenosis and bilateral recess compromise (right greater than left) and without neural foraminal compromise.3.Unremarkable images at other levels.