Male, 52 years old, with severe right lumbar radiating pain. Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No pathologic marrow replacement or enhancement is seen.The distal spinal cord is unremarkable. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina dispersed evenly through the thecal sac. No pathologic intrathecal enhancement is seen. No epidural abnormalities are suspected.Incidental note is made of mild prominence of the right renal collecting system.Mild loss of disc T2 signal is seen at L2-3 and L4-5 with preservation of disc height. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild bulging disc with a shallow central/right paracentral protrusion. Mild effacement of the ventral thecal sac but no significant generalized canal stenosis. No significant foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Right foraminal and extraforaminal disc protrusion which moderately narrows the neural foramen. The exiting L3 nerve root does not appear to be significantly impinged. However, the protrusion may impinge the descending right L4 nerve root. No significant generalized spinal canal stenosis. No significant left foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal stenosis with encroachment of the lateral recesses and crowding of the descending bilateral L5 nerve roots. Superimposed left foraminal/far lateral disc protrusion which moderately narrows the left neural foramen. L5-S1: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.
1.A right foraminal/extraforaminal disc protrusion at L3-4 causes moderate narrowing of the neural foramen. The exiting L3 nerve root does not appear to be impinged. However, this protrusion does efface the right lateral recess and may impinge on the descending right L4 nerve root.2.A bulging disc at L4-5 causes encroachment of the lateral recesses and crowding of the descending bilateral L5 nerve roots. A superimposed left foraminal/far lateral disc protrusion causes moderate left neuroforaminal narrowing.