Female, 44 years old, with obesity, left lower extremity weakness, and incontinence of bowel and urine, also with radicular low back pain. Assess for cord compression. No significant spinal canal stenosis or cord compression is seen in the cervical region.In the thoracic spine, there is prominence of the dorsal epidural fat most notably from T3-4 through T8-9 which results in moderate to severe spinal canal narrowing and perhaps some mass effect on the spinal cord. In addition, there is significant facet arthropathy and ligamentum flavum thickening at T4-5, T5-6 and T6-7. At T4-5, there is questionable abnormal cord signal intensity.Beginning with T5, the endplates of the thoracic vertebral bodies are irregular and most levels show a slight anterior wedging which could reflect Scheuermann's disease.In the lumbar spine, disc degeneration and endplate signal abnormality are seen at L5-S1. In addition, there is a large inferiorly directed L5-S1 disc extrusion which narrows the spinal canal at the S1 level, potentially impinging on transiting nerve roots. Elsewhere, no significant stenosis seen within the lumbar spine.Spinal alignment is relatively anatomic allowing for straightening of the cervical lordosis. Except as discussed in the thoracic region, vertebral body heights are preserved. Scattered degenerative marrow signal change is noted.
1.Prominence of the dorsal epidural fat is seen in the thoracic spine, most notably from T3-4 through T9. This, along with facet hypertrophy and ligamentum flavum thickening at T4-5, T5-6 and T6-7, contributes to a moderate to severe generalized narrowing of the thoracic spinal canal with perhaps some mass effect on the cord. There is questionable cord signal abnormality at T4-5. Findings could be better assessed with dedicated thoracic spine imaging.2.Disc degeneration is seen at L5-S1, and in particular, there is a large inferiorly directed disc extrusion which significantly narrows the spinal canal at the S1 level potentially impinging on traversing nerve roots. Findings could be better assessed with dedicated lumbar spine imaging.