89-year-old female with hypothyroidism, hypertension, dementia, admitted with exacerbation of right-sided sciatica. Five lumbar type vertebral bodies are presumed to be present. There is a Schmorl's node involving the superior endplate of the T11 vertebral body with approximately 35 % loss of height involving the left aspect of the vertebral body suggestive of a mild chronic compression fracture. Small Schmorl's nodes are also noted involving the inferior L2 and upper and lower L3 endplates. Vertebral body heights are otherwise maintained. Alignment is grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen with disc height loss and vacuum phenomena evident at the L1-L2, L2-L3, and L3-L4 levels. Individual levels, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: There is mild disc bulge, bilateral facet arthropathy, as well as a cystic structure dorsally which may represent a ligamentum flavum cyst versus a synovial cyst associated with the facet arthropathy. There is overall mild to moderate spinal canal stenosis at this level. There is mild bilateral neural foraminal stenosis.L3-L4: There is a large right-sided disc extrusion which effaces the right lateral recess and extends caudally along the dorsal aspect of the L4 vertebral body to the level of the L4-L5 disc. The inferior aspect of the extruded disc material appears to be in contact with the remainder of the disc material superiorly, but may represent a free fragment. There is also ligamentum flavum thickening and bilateral facet arthropathy contributing to severe spinal canal stenosis at this level. There is moderate to severe right-sided neural foraminal stenosis and moderate left-sided neural foraminal stenosis.L4-L5: There is a disc bulge eccentric to the right with ligamentum flavum thickening and bilateral facet arthropathy contributing to mild to moderate spinal canal stenosis. There is also moderate right and mild left neural foraminal stenosis. L5-S1: Minimal disc bulge and bilateral facet arthropathy with distended facet joints. There is no significant spinal canal or neural foraminal stenosis.Fatty atrophic changes are noted involving the lower lumbar paraspinous musculature at the L5 level, right greater than left. Bilateral renal cysts noted. Degenerative changes are also noted at the right T12 costovertebral joint with associated surrounding bone marrow edema.
Multilevel degenerative changes in the lumbar spine which are severe at the L3-L4 level. There is severe spinal canal stenosis as well as moderate to severe right-sided neural foraminal stenosis at this level. There is also a disc extrusion with inferior migration which appears to originate from the L3-L4 level and migrates inferiorly to the L4-L5 level, and is associated with complete effacement of the right lateral recess. There is suspected impingement of the exiting right L3 nerve root as well as the descending L4 nerve root.Please see findings at additional details as above.