53-year-old woman with history of fall from horse, left pubic ramus fracture, and urinary incontinence. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Lumbar spine alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at L1. Of note there is thin, discontinuous linear T1 hyperintense signal extending from the L2/3 to lower L4 level and again from the L5 level to the distal thecal sac. This appears similar to the prior examination from 2012 and is of normal thickness.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a minimal disc bulge without spinal canal or neural foraminal stenosis.L4-L5: There is a minimal disc bulge without spinal canal or neural foraminal stenosis. There is a small right perineural cyst.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There is a small left perineural cyst.There is a curvilinear area of T1 hypointensity and T2 hyperintensity extending from the anterior left sacral ala to the left lateral margin of the S1-S2 foramen (501/3). There is increased T2 signal in the surrounding marrow, however no evidence of significant cortical displacement. There are cysts in the right lobe of the liver and right kidney, otherwise the paraspinous soft tissues are within normal limits.
1.Incompletely visualized nondisplaced left sacral alar fracture extending to the margins of the dorsal sacral foramina, with prominent associated bone marrow edema. CT can be considered for further characterization if clinically warranted.2.Incidentally noted discontinuous fatty filum terminale which can be a normal variant but could also be seen in tethered cord syndrome, please correlate with clinical history.