Male, 71 years old, with low back pain, worsening over the past 9-10 months. Alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are mildly heterogeneous but no concerning marrow replacement or marrow edema is seen.The visualized distal spinal cord and conus are unremarkable. The spinal canal is congenitally slender. The discs show loss of height. Additional level specific findings are as follows:Low thoracic spine: Mild disc bulging, only assessed on sagittal images.L1-2: Mild facet arthropathy. Mild bulging disc. Prominence of the epidural fat. Mild spinal canal narrowing. No significant foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild bulging disc. Prominence of the dorsal epidural fat. Mild to moderate generalized spinal canal narrowing with borderline crowding of the cauda equina. No significant foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Prominence of the dorsal epidural fat. Moderate generalized spinal canal narrowing with exclusion of CSF and crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Prominence of the dorsal epidural fat. Mild to moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Severe right and moderate to severe left foraminal narrowing.
Spinal canal narrowing is seen at L3-4, L4-5, and to a lesser degree at L2-3, due to a combination of disc degeneration, posterior element hypertrophy, prominence of the dorsal epidural fat and a congenitally slender spinal canal. Significant foraminal narrowing is also evident bilaterally at L5-S1.