Male, 69 years old, with right-sided sciatica. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. Fairly substantial endplate edema is seen at L4-5, particularly on the right, with smaller areas of endplate edema noted at L1-2 and L2-3.The visualized distal spinal cord and conus are within normal limits. No significant epidural abnormalities are suspected, though there is a mild generalized prominence of the dorsal epidural fat in the lumbar region.L1-2: Mild loss of disc height and disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Mild disc bulging. Mild spinal canal narrowing with slight crowding of the cauda equina. No significant foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Disc bulging. Moderate to severe spinal canal narrowing with crowding of the cauda equina and near complete effacement of CSF. Mild bilateral foraminal narrowing.L4-5: Marked facet arthropathy with a large facet effusion on the right. Ligamentum flavum thickening. Disc bulging. Moderate to severe spinal canal narrowing with crowding of the cauda equina and effacement of CSF. Severe right foraminal narrowing with probable nerve root impingement. Mild left foraminal narrowing. L5-S1: Marked facet arthropathy. Disc bulging asymmetric to the left. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing.
Multilevel degenerative disease is seen, most notably affecting the L4-5 level where facet arthropathy and disc bulging result in a moderate to severe spinal canal stenosis and a severe right-sided foraminal narrowing with nerve root impingement. Fairly significant bilateral foraminal narrowing is also seen at L5-S1.