Mid lumbar spine tenderness and pain, intermittent left leg weakness and falls. Sickle cell disease/thalassemia Five lumbar type vertebral bodies are presumed to be present. There are central sharply delimited endplate depressions involving the T11, T12, L1, and L2 vertebral bodies which can be seen with sickle cell anemia. There is linear as well as horizontal T2 signal involving the L5 vertebral body which may represent a fluid filled cleft related to prior osteonecrosis. Overall vertebral body height is maintained. Severe endplate degenerative changes are seen at the L5-S1 level with low T1 and low T2 signal likely reflecting sclerosis. There is severe loss of disc height at the L5-S1 level and to a slightly lesser degree from L1-L2 to the L4-L5 levels. There is loss of lumbar lordosis. There is mild retrolisthesis of L2 on L3, L3 on L4, L4 on L5, and L5 on S1. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Disc bulge. No significant spinal canal or neural foraminal stenosis.L2-L3: Disc bulge with superimposed right central disc extrusion resulting in mild central spinal canal stenosis. There is effacement of the right lateral recess. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal stenosis.L3-L4: There is disc bulge and central protrusion with ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: Diffuse disc bulge, and ligamentum flavum thickening resulting in moderate to severe spinal canal stenosis. Minimal bilateral neural foraminal narrowing.L5-S1: There is disc bulge and ligamentum flavum thickening and prominence of the epidural fat resulting in moderate degree of spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis where there may be impingement of the bilateral L5 nerve roots.There are changes secondary to sickle cell disease involving the bilateral kidneys including evidence of prior infarcts on the left. Left kidney small.
1. Degenerative changes throughout the lumbar spine as detailed above with moderate to severe spinal canal stenosis at L4-L5 and moderate spinal canal stenosis at L3-L4 and L5-S1. There is also multilevel neural foraminal narrowing, worst at L5-S1 where there is moderate to severe bilateral neural foraminal stenosis and possible impingement of the bilateral L5 nerve roots. 2. Central endplate depressions involving the T11, T12, L1, and L2 vertebral bodies which can be seen with sickle cell anemia related to endplate infarcts. There is linear as well as horizontal T2 signal involving the L5 vertebral body which may represent a fluid filled cleft related to prior osteonecrosis. Overall vertebral body height is maintained. 3. Partially assessed findings of sickle cell nephropathy. Dedicated abdominal imaging can be considered if clinically indicated.