Female, 57 years old, with low back pain. Evaluate for stenosis. Spinal alignment is anatomic. Vertebral body heights are preserved. Endplate degenerative signal alteration is seen, but otherwise, no pathologic marrow replacement is seen. There is mild edema of the bilateral L4-5 facet complexes.The visualized distal spinal cord and conus are within normal limits. The cauda equina becomes crowded at lower lumbar levels due to both degenerative changes and prominence of the epidural fat.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet arthropathy. Ligamentum flavum thickening. Loss of disc height and mild disc bulging with a new right foraminal protrusion. In combination with prominence of the epidural fat, there is a moderate generalized spinal canal stenosis. The right neural foramen is mildly narrowed. No interval changes except as discussed. L3-4: Advanced facet arthropathy. Ligamentum flavum thickening. Loss of disc height with mild disc bulging and a small left paracentral extrusion. Mild spinal canal stenosis. The neural foramina are patent. No interval changes. L4-5: Advanced facet arthropathy. Ligamentum flavum thickening. Loss of disc height and disc bulging. Prominence of the epidural fat. Moderate spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Loss disc height with disc bulging. Prominence of the epidural fat. No significant spinal canal stenosis. Mild to moderate foraminal narrowing.
Multilevel disc and posterior element degeneration is again seen. Along with prominence of the epidural fat, these findings result in narrowing of the thecal sac most notably at L4-5 where there may be some crowding of the cauda equina. A small right foraminal disc protrusion at L2-3 seems to be new. Otherwise, no significant interval changes are noted.