Female, 68 years old, with non-small cell lung cancer undergoing treatment, now with lumbar back pain, left lower extremity radiation, weakness, and urinary retention symptoms. A dextroscoliosis of the thoracic spine is seen which does mildly affect the lumbar spine as well. A grade 1/2 anterolisthesis of L4 relative to L5 is demonstrated.Severe disc degeneration is seen at L4-5. There is mild degenerative irregularity of the inferior L4 endplate but severe irregularity of the superior L5 endplate. The L5 vertebral body is mildly wedged anteriorly but without evidence of edema.The remaining vertebral bodies demonstrate normal morphology and signal characteristics. No areas of suspicious marrow replacement or marrow edema are observed.The visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below.T12-L1: Small left paracentral disc extrusion. No significant spinal canal stenosis. No significant foraminal narrowing.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy. Mild ligamentum flavum thickening. Minimal laterally bulging disc. No significant spinal canal stenosis. No significant foraminal narrowing. L4-5: Advanced facet hypertrophy and ligamentum flavum thickening. Spondylolisthesis with disc uncovering. Moderately severe generalized spinal canal stenosis with crowding of the nerve roots of the cauda equina. Severe right worse than left foraminal narrowing with possible nerve root impingement. L5-S1: Facet hypertrophy. Ligamentum flavum thickening. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Incidental note is made of bilateral renal cystic lesions.
1.Multilevel degenerative findings, with the most severe disease at L4-5. There is a grade 1/2 spondylolisthesis at this level which, along with posterior element hypertrophy, contributes to a moderately severe generalized spinal canal stenosis with crowding of the cauda equina. There is also severe bilateral foraminal narrowing, right worse than left, with possible nerve root impingement.2.No suspicious marrow edema or marrow replacement is seen to suggest presence of metastatic disease.