Provided clinical information:
33 years, Female, "low back pain
radiating down left leg to left
foot, symptoms times one month, pain
not improved after physical
therapy"
Procedure and materials: Standard
protocol.
Contrast: None.
Potential limitations: None.
Comparison studies: None.
Observations:
The vertebral bodies are normal
in height and alignment. There are
mild endplate degenerative changes
at L4-L5. Otherwise, marrow signal
appears within normal limits.
There is loss of height and signal of
the L2-L3 through L5-S1 intervertebral
discs. The conus medullaris is
normal in position and appearance.
Axial images:
T12-L1: No disc protrusion,
central canal stenosis or foraminal
narrowing is identified.
L1-L2: No disc protrusion, central
canal stenosis or foraminal
narrowing is identified.
L2-L3: There is a mild disc
bulge with a superimposed broad-based
central disc protrusion. High
T2 signal is seen posteriorly in
keeping with a posterior annular
fissure. Mild bilateral facet
hypertrophy is present. This
results in mild central canal stenosis.
No significant neural foraminal
narrowing is identified.
L3-L4: There is a mild diffuse
disc bulge with a superimposed
broad-based central disc protrusion.
Bilateral facet hypertrophy is
present. This results in mild
central canal stenosis and minimal
neural foraminal narrowing bilaterally,
left greater than right.
L4-L5: There is a diffuse disc
bulge with a large central to left
paracentral disc protrusion
which extends to the left lateral recess.
This measures approximately
1.9 cm in craniocaudal dimension and
appears to impinge upon the
traversing left L5 nerve root. Bilateral
facet hypertrophy is present.
This results in moderate central canal
stenosis and minimal bilateral
neural foraminal narrowing.
L5-S1: There is a diffuse disc
bulge with likely a small superimposed
central disc protrusion. No
significant central canal stenosis is
identified. There appears to
be moderate left-sided neural foraminal
narrowing.
The visualized paravertebral
soft tissues appear unremarkable.
Impression:
Multilevel degenerative changes
as described, most advanced at L4-L5
where there is a large central
to left paracentral disc protrusion
extending to the left lateral
recess which appears to impinge upon
the traversing left L5 nerve
root. Moderate left-sided neural
foraminal narrowing is also
seen at L5-S1. See above for level by
level details.