His reply was, "About a 3 or 4."
I like those numbers.
MRI LUMBAR SPINE WITH CONTRAST
CLINICAL HISTORY: Worsening sciatica
PROCEDURE: Coronal and sagittal T1-weighted, sagittal T2-weighted, and axial dual-echo sequences of the lumbar spine were performed on a 1.5T Siemens Vision Magnetic Resonance Imaging System. Postgadolinium axial and sagittal T1-weighted images were also performed.
FINDINGS: There is normal anatomic alignment of the lumbar spine. There is normal bone marrow signal intensity.
The T12-L1, L1-L2, and L2-L3 intervertebral discs appear intact.
At the L3-L4 disc level there is moderate disc desiccation with associated mild degenerative endplate changes and minimal anterior and marginal osteophyte formation. In addition, there is a 5 to 6 mm (anteroposterior) broadbased left paracentral-lateral disc extrusion which is abutting posteriorly displacing, i.e. apparently impinging upon the traversing left L4 nerve root. This is best demonstrated on image number 28 of the axial T2-weighted sequence and postcontrast image number 6 of the sagittal T1-weighted sequence. There is resultant moderate to severe compression upon the left ventral aspect of the thecal sac. The extruded disc extends by approximately 5 mm in the cephalocaudal dimension posterior of the left aspect of the L4 vertebral body. In addition, there is moderate facet joint arthropathy with resultant mild central canal stenosis and mild bilateral neural foraminal stenosis.
At the L4-L5 disc level there is moderate disc desiccation with associated mild degenerative endplate changes and small anterior and marginal osteophyte formation. In addition, there is a 3 mm broadbased posterior central disc protrusion with resultant mild compression upon the ventral aspect of the thecal sac. There is a tear of the central aspect posterior annulus. In addition, there is moderate facet joint arthropathy which in combination with the disc protrusion and congenitally shortened pedicles has resulted in mild central canal and mild bilateral neural foraminal stenosis.
At the L5-S1 disc level there is moderate disc desiccation with associated mild degenerative endplate changes. In addition, there is a 3 to 4 mm asymmetric broadbased posterior disc bulge which is more prominent in the right lateral aspect central canal where it is abutting without significantly displacing the traversing right S1 nerve root. This is best demonstrated on image number 41 of the axial T2-weighted sequence. In addition, there is moderate facet joint arthropathy at this level which in combination with congenitally shortened pedicles has resulted in mild central canal and mild left neural foraminal stenosis. There is no significant right neural foraminal stenosis.
The conus, medullaris, and thecal sac otherwise appear normal. There is no evidence of abnormal enhancement following contrast administration. The limited imaging of the prevertebral soft tissues is unremarkable.
IMPRESSION:
1. L3-L4: 5 to 6 mm (anteroposterior) broadbased left paracentral-lateral disc extrusion which is abutting posteriorly displacing, i.e., apparently impinging upon the traversing left L4 nerve root. There is resultant moderate to severe compression upon the left ventral aspect of the thecal sac. In addition, there is moderate facet joint arthropathy with resultant mild central canal stenosis and mild bilateral neural foraminal stenosis.
2. L4-L5: 3 mm broadbased posterior central disc protrusion with resultant mild compression upon the ventral aspect of the thecal sac. There is a tear of the central aspect posterior annulus. In addition, there is moderate face joint arthropathy with in combination with the disc protrusion and congenitally shortened pedicles has resulted in mild central canal and mild bilateral neural foraminal stenosis.
3. L5-S1: 3 to 4 mm asymmetric broadbased posterior disc bulge which is more prominent in the right lateral aspect central canal where it is abutting without significantly displacing the traversing right S1 nerve root. In addition, there is moderate facet joint arthropathy at this level which in combination with congenitally shortened pedicles has resulted in mild central canal and mild left neural foraminal stenosis. There is no significant right neural foraminal stenosis.
