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FIG 7. Images of a 56-year-old man with right leg pain and anterior thigh pain. Neurogenic claudication was not present. The patient had a history of surgery at L3–L4 and L4–L5.
A-C, Contiguous axial view proton density–weighted MR images show a small canal at L2–L3 but no overt evidence of root compression. Both observers labeled this as grades 0 and 1 bilaterally.
D, Anteroposterior view conventional myelogram obtained with the patient in the prone position shows a relatively normal canal at L2–L3 (arrow).
E, Lateral view conventional myelogram obtained with the patient in the prone position shows a normal canal at L2–L3 (short arrow).
F, Lateral view conventional myelogram obtained at the L2–L3 level with the patient in the standing extended position shows reduction in canal size with some posterior defect likely related to buckling of the ligamentum flavum while in extension, leading to some degree of spinal stenosis (arrow). Surgical findings documented lateral recess root compression bilaterally at L2–L3. Postoperatively, the patient achieved moderate recovery of strength and sensation, with improvement in right leg pain by the time of discharge.
G-J, Contiguous axial post-myelogram CT images obtained at the L2–L3 level show a small canal and slight lateral recess distortion bilaterally (G, arrows). One observer graded this level as small lateral recesses but no root compression (grade 1), and the other observer graded this as root compressive (grade 2).
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