46-year-old female with persistent lower back pain radiating to the left lower extremity, onset following a workplace lifting injury on 11/08/2024. Conservative management with NSAIDs, physical therapy, and a course of oral prednisone taper over six weeks has provided incomplete relief. The patient continues to report 7/10 pain with positional sensitivity.
Sagittal T1, sagittal T2, axial T2, and STIR sequences obtained without contrast through the lumbar spine. Image quality is diagnostic. No prior imaging available at the time of review.
Five lumbar-type vertebrae numbered conventionally. Vertebral body heights are preserved. No acute marrow edema. Mild Modic Type II endplate changes at L4-L5.
At L4-L5 there is a large left paracentral disc extrusion measuring approximately 8 mm in AP dimension, extending into the lateral recess and producing moderate-to-severe mass effect on the traversing left L5 nerve root. Disc material extends superiorly approximately 6 mm. The thecal sac is moderately deformed. At L5-S1 there is a smaller central disc protrusion (~3 mm) without nerve root impingement. L1-L2 through L3-L4 are unremarkable.
Central canal AP dimension is 9 mm at L4-L5, consistent with moderate central canal stenosis. The left L4-L5 neural foramen demonstrates moderate-to-severe narrowing. Right L4-L5 foramen is mildly narrowed. All other foramina are patent.
No abnormal paraspinal mass. Facet joints demonstrate mild bilateral facet arthropathy at L4-L5 and L5-S1, more pronounced on the left.
Large L4-L5 left paracentral disc extrusion with moderate central canal stenosis and severe left L5 nerve root mass effect. Findings correlate with the patient's reported left lower-extremity radiculopathy. Recommend neurosurgical consultation. Small L5-S1 central disc protrusion without significant mass effect.
— Electronically signed K. Adams, MD · 2024-11-22 16:41 PT