History of breast cancer, low back pain with right leg radiation. Rule out lytic lesion. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4 and L4 on L5. Alignment is otherwise maintained. Bone marrow signal is diffusely heterogeneous which is nonspecific but without discrete destructive osseous lesions evident. T1 hyperintense lesion at the right S1 level is compatible with a hemangioma. The conus medullaris is normal in position. No suspicious epidural or leptomeningeal enhancement. There is enhancement associated with facet arthropathy, particularly at the L4-L5 level.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 disc desiccation and height loss as well as a disc bulge with right paracentral protrusion component. There is associated effacement of the right lateral recess. Bilateral facet arthropathy. There is moderate to severe central spinal canal stenosis. Mild to moderate right and mild left neural foraminal narrowing. L4-L5: There is disc desiccation and disc height loss. There is a central dorsal annular fissure. There is advanced bilateral facet arthropathy, ligamentum flavum thickening, and mild disc bulge which contribute to moderate to severe spinal canal stenosis at this level. 5 mm cystic lesion in the right dorsal lateral epidural space which is favored to represent a synovial cyst also contribute to the spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing. L5-S1: There is disc desiccation and disc height loss. There is disc bulge with a small central protrusion component. There is moderate facet arthropathy, particularly on the left. There is no significant spinal canal stenosis. There is mild neural foraminal narrowing, relatively worse on the left.Paraspinous soft tissues are within normal limits.
1. No evidence of metastatic disease in the lumbar spine.2. Advanced degenerative changes in the lumbar spine at the L3-L4 and L4-L5 level with moderate to severe spinal canal stenoses at these levels. Effacement of the right lateral recess at L3-L4 and mild to moderate right L3-L4 and right L4-L5 neural foraminal stenosis may be contributing to patient's right leg symptoms.3. Advanced facet arthropathy at the L4-L5 level including small synovial cyst which contributes to the above-mentioned moderate to severe spinal canal stenosis at this level. There is also grade 1 anterolisthesis at L3-L4 and L4-L5.