Male, 63 years old, with radiating right lower extremity pain and numbness. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous. Signal abnormality and enhancement are seen along the L4 superior endplate compatible with a Schmorl's node. Scattered additional nonenhancing Schmorl's nodes are also seen. Small enhancing foci along the superior L2 endplate are nonspecific but likely benign.The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. No pathologic intraspinal enhancement is seen.L1-2: Bulging disc. Mild generalized spinal canal narrowing. No significant foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing with slight crowding of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal narrowing with crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal narrowing with crowding and likely impingement of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy left worse than right, and ligamentum flavum thickening. Bulging disc asymmetric to the left. Effacement of the left lateral recess and moderate generalized spinal canal narrowing. Moderate left and mild right foraminal narrowing.
Multilevel disc and posterior element degeneration is seen. This results in a severe spinal canal stenosis at L4-5 and a moderate to severe stenosis at L3-4.