Reason for Study: Low back pain [M54.5], Reason for Study: ^Reason: r/o spinal stenosis History: on going back pain. Chronic with flares. Abn x ray of L/S spine. Not much improvement with PT For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is grade 1 anterolisthesis of L5 on S1.There are diffuse bone marrow edema on both L5 and S1 vertebral bodies with high signal intensity of L5S1 disc. Considering the degree of anterolisthesis, the extent of bone marrow edema is a bit excessive. Therefore, the possibility of discitis may need to be excluded.There is normal lumbar lordosis. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. There is a focal central protrusion of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L5-S1: Grade 1 anterolisthesis of L5 5 on S1 with the subtle bulging of L5-S1 disc. High signal intensity of L5-S1 disc with associated post L5 and L1 vertebral bodies bone marrow edema are seen. The extent of bone marrow edema appears to be more excessive than usual acute disc degeneration related inflammatory change (Modic 1 change). Therefore, possibility of discitis may need to be excluded. Contrast enhanced MRI can be considered for further imaging evaluation. No neuroforaminal narrowing or spinal stenosis.
1. Bone marrow edema of both L5 and S1 vertebral bodies with focal high signal intensity of L5S1 disc, indicate diagnostic possibilities of discitis and excessive endplate degenerative changes (Modic 1 change). Gad enhanced MRI can be considered for further imaging evaluation.2. Grade 1 anterolisthesis of L5 on S1.3. Multilevel various degree degenerative changes of lumbar spine. 