64-year-old female with back pain. There are five lumbar type vertebral bodies. There is straightening of the normal lumbar lordosis. Vertebral body heights are maintained. Degenerative marrow changes are present in the L4, L5, and S1 vertebral bodies. Otherwise, bone marrow signal intensity is within normal limits. There is endplate irregularity at L4-5 and, to a lesser extent, at L5-S1 with loss of disc height at these levels. The conus medullaris terminates at L2-3.The mid to distal lumbar spine developmentally narrowed due to short pedicles and slight proliferation of the dorsal epidural fat. There is redundancy and thickening of the cauda equina nerve roots.On sagittal images at T9-10 and T10-11, there are diffuse disc bulges resulting in moderate spinal canal narrowing at both levels, with and moderate neural foraminal narrowing at T9-10. At T10-11, there is moderate to severe bilateral neural foraminal narrowing.T11-12: Mild disc bulge results in flattening of the ventral thecal sac. No significant compromise the neural foramina.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina. Trace fluid in the right facet joint is likely degenerative in etiology.L2-L3: There is ligamentum flavum thickening a mild disc bulge with superimposed right distal foraminal/far lateral shallow disc protrusion resulting in mild right greater than left neural foraminal narrowing and mild central spinal canal narrowing.L3-L4: There is ligamentum flavum thickening and mild disc bulge resulting in moderate left and mild right neural foraminal narrowing and moderate central spinal canal narrowing.L4-L5: There is moderate diffuse disc bulge, severe ligamentum flavum thickening and moderate facet joint arthropathy resulting in severe central spinal canal narrowing, severe right neural foraminal and moderate left neural foraminal narrowing.L5-S1: There is mild diffuse disc bulge resulting in moderate central spinal stenosis, mild to moderate right neural foraminal and moderate to severe left neural foraminal narrowing. There is fluid in the facet joints bilaterally.
1.Multilevel degenerative changes worse at L4-5 where there is severe central spinal canal narrowing, severe right neural foraminal and moderate left neural foraminal narrowing.2.Underlying mid to distal lumbar spine developmental narrowing.