Female, 72 years old, with back pain and lumbar stenosis. Preoperative planning for decompression. A grade 1 anterolisthesis of L5 relative to S1 is new compared to the 2006 examination. Sagittal alignment is otherwise unremarkable.A T2 hyperintense and T1 heterogeneous lesion within the anterior aspect of the L3 vertebral body is unchanged and likely represents an atypical hemangioma. No other suspicious marrow space lesions are seen. No evidence of marrow edema is detected.Visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below. No epidural abnormalities are observed.L1-2: Mild facet arthropathy, progressed. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy and ligamentum flavum thickening, progressed. Minimal bulging disc, progressed. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy and ligamentum flavum thickening, progressed. Mild predominantly laterally bulging disc without change. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged. L4-5: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Minimally bulging disc, slightly progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina, worse from prior. Mild bilateral foraminal narrowing is unchanged. L5-S1: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Disc uncovering and disc bulging, with mild loss of disc height, progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina equina nerve roots which is progressed. Mild to moderate bilateral foraminal narrowing is also progressed.
1.Progressive degenerative disease is seen most notably at L4-5 and L5-S1. In combination with a congenitally slender spinal canal, disc and posterior element degeneration results in a significant spinal canal stenosis at these levels.2.Relatively mild degenerative findings are slightly progressed at other levels, most particularly involving the facet joints.