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Severe bilateral foraminal stenosis & large synovial cyst

I need help in Understanding my MRI report so that I can make "wise" decisions regarding treatment (steroid shot or surgery): "At L4-5 there is a diffuse bulge flattening the thecal sac. There is ligamentum flavum and facet hypertrophy contributing to mild canal stenosis, as well as moderate to severe bilateral foraminal stenosis and minimal anterier subluxation. At L5-S1 there is a left hemilaminectomy with severe facet disease with associated severe foraminal stenosis. There is no canal stenosis. There is a large synovial cyst extending posterolaterally at the L5-S1 facet."
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replied October 25th, 2011
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Marispine,

I can help you with the terminology:

"At L4-5 there is a diffuse bulge flattening the thecal sac." >> Here the disc bulges posteriorly towards the spinal canal. It touches the thecal sac, which is the sheath that goes around the spinal cord. But at this level, there is no solid spinal cord. The cord actually ends at the level of L1. At the L4-5 the thecal sac contains only the terminal nerve roots floating in the cerebrospinal fluid. Which is why spinal taps can be done in the lower lumbar region without too much risk to the neural structures.

"There is ligamentum flavum and facet hypertrophy contributing to mild canal stenosis, as well as moderate to severe bilateral foraminal stenosis and minimal anterior subluxation." >> Canal stenosis means that the spinal canal is narrowed. This is due to hypertrophy, or overgrowth, of the ligamentum flavum, which is a series of stout ligaments on the inside of the spinal canal. Also, contributing to this narrowing is the hypertrophy of the posterior facet joints. When these joints start to degenerate, they overgrow, producing osteophytes, which are bone spurs.
The neural foramina are the holes through which the nerve roots exit the spine. On both sides, the holes are very narrowed. But, it does not say if the nerve roots are actually being compressed.
There is "minimal" spondylolisthesis, or anterior subluxation, which is where the superior (above) vertebra moves forward on the inferior (below) one. But, no actual Grade of slip is given, so it is probably very small.

"At L5-S1 there is a left hemilaminectomy with severe facet disease with associated severe foraminal stenosis." >> At this level, there has been a surgical procedure which has removed the left lamina, a posterior element of the vertebral ring. The foramina is very narrowed in this region also, from significant facet joint hypertrophy. Again, it does not say if the nerve root is being compressed or not.

"There is no canal stenosis. There is a large synovial cyst extending posterolaterally at the L5-S1 facet." >> Here the spinal canal is not narrowed. But, again there is significant facet joint degeneration, manifested by a synovial cyst (another sign of joint degeneration). The cyst involves the joint, as expected it should.


As to the significance of these findings is something that you need to discuss with your surgeon. The findings need to be correlated with your history and physical examination.

Good luck.
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