T1 pre-gad T2 FSE T2 FSE

Diagnosis: Spinal stenosis

Spinal stenosis results from the cumulative effect of degenerative changes which occur in the spine over many years. Changes are more pronounced in men and in those patients who have performed vigorous physical activity over the years. In the lumbar spine, L4-5 and L5-S1 are the most commonly affected sites. Among the processes that contribute to the overall severity of spinal stenosis are hypertrophy of the ligamentum flavum and the articular facets, bulging of the annulus fibrosis, osteophyte formation, as well as congenitally short pedicles. Synovial cysts of the articular facet joint may be seen and may also contribute to the overall degree of narrowing. Spondylolisthesis is another process which may contribute to the narrowing.

Patients typically present with symptoms of pseudoclaudication where they have lower extremity pain with walking which tends to be relieved with leaning forward. The classic way to differentiate pseudoclaudication from vascular claudication is by the clinical story. The spinal stenosis patient describes relief of symptoms when going up stairs since most people tend to bend forward when climbing. On MR, the severity of the central canal narrowing is best evaluated on the T2 axials. Abnormal intradural gadolinium enhancement has been described above severely stenotic levels in the lumbar spine. This is thought to be due to obstructed veins and break down of the blood nerve barrier due to inflammation. This patient underwent a decompressive laminectomy from L3 to L5 with medial facetectomy on the right L4-5 with removal of the focal disk protrusion. Related Cases

Jinkins JR. Gd-DTPA enhanced MR of the lumbar spinal canal in patients with claudication. J Comput Assist Tomogr, Jul-Aug 1993; 17(4):p555-62.















































Synovial cyst Synovial cyst Lateral HNP