Gait abnormality. Evaluate for radiculitis. Alignment is notable for 3 mm of anterior subluxation of L4 relative to L5 as a result of facet degenerative disease. This is associated with mild height and T2 signal loss at L4-L5 disc. Alignment is otherwise anatomic and the other discs are preserved in height and T2 signal. Vertebral bodies are preserved in height. Foci of fat-signal are present in L2, L4 and S1 bodies. Otherwise, marrow signal heterogeneity is associated with complete suppression on the fat suppressed sequences and therefore most likely of no significance. The spinal canal is moderately to severely narrowed at L4-L5 level. It is preserved at the other levels. Only on the sagittal STIR images, there is a small focus of increased signal in the posterior aspect of the spinal cord at T11-T12 intervertebral level. This is not covered on the axial images and is not conspicuous on the other sagittal sequences and therefore may very likely be artifactual. Otherwise, the conus medullaris has normal morphology and signal. The tip of the conus medullaris is at the L1-L2 level.T12-L1: There is no central or foraminal stenosis.L1-L2, L2-L3 and L3-L4: Disc bulges are minimal. There is no central or foraminal stenosis.L4-L5: Anterior subluxation is associated with uncovering of the disc. There is also facet hypertrophic change and ligamenta flava buckling. Together, these result in moderate to severe central spinal narrowing. The subarticular recesses are also narrowed and there is mild right and left foraminal narrowing.L5-S1: There is mild facet hypertrophic change but no central or foraminal narrowing. Small renal lesions are not completely assessed though likely cysts.
1.Moderate to severe narrowing of the central and lateral spinal canal at L4-L5 is caused by spondylolisthesis/disc uncovering and posterior element hypertrophy/thickening as described above. Moderate right and mild left foraminal narrowing.2.Spondylosis at the other levels is minimal.3.A focus of apparent signal abnormality in the lower spinal cord seen only on the sagittal STIR sequence is likely artifactual.