Male, 82 years old, with weakness in the proximal legs bilaterally, possibly worse on the left. A mild scoliotic curvature of the lumbar spine is seen. There is a grade 1 anterolisthesis of L4 relative to L5, and a grade 1 retrolisthesis of L5 relative to S1. Vertebral body height and morphology are within normal limits allowing for some right lateral degenerative wedging of L3 and L4. No evidence of concerning marrow replacement is seen. Endplate edema is noted at L3-4 related to disc degeneration. No other areas of significant marrow edema are seen.The visualized distal spinal cord is unremarkable. The conus tip terminates at the L1-2 level which is normal. The nerve roots of the cauda equina are unremarkable except as discussed below.The discs of the lumbar spine show loss of height and loss of T2 signal characteristics. The endplates demonstrate degenerative irregularity. Bulky anterior osteophytes are present at all levels. Additional level specific findings are as follows.T12-L1: Mild left facet hypertrophy. Mild bulging disc with a shallow left paracentral protrusion. Narrowing of the left lateral recess. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with mild crowding of the cauda equina. Severe left and moderate right foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with mild crowding of the cauda equina. Moderate bilateral foraminal narrowing. L3-4: Facet hypertrophy, worse on the right, and ligamentum flavum thickening. Bulging disc. Moderate to severe generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. L4-5: Marked facet hypertrophy bilaterally. Ligamentum flavum thickening. Disc bulging and disc uncovering due to spondylolisthesis. Severe generalized spinal canal stenosis with complete exclusion of CSF and likely impingement of the cauda equina nerve roots. Moderate right and mild left foraminal narrowing. L5-S1: Mild facet hypertrophy. Mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Cortical thickening and irregularity is seen along the left SI joint. The visualized left iliac bone shows heterogeneous marrow signal and the cortical margins are somewhat irregular as well.
Significant disc degeneration is seen at all levels of the lumbar spine. The L4-5 level is most significantly affected with a severe generalized spinal canal stenosis and likely impingement of the descending cauda equina nerve roots. Moderate spinal canal stenosis is seen at L3-4 and at L2-3.Also noted is cortical thickening and irregularity along the left SI joint. In addition, the left iliac bone as visualized demonstrates heterogeneous marrow signal characteristics and ill-defined margins. These findings are of uncertain significance. Correlation with history of prior trauma is suggested. Based on this examination, the findings appear chronic, and the need for dedicated imaging should be determined clinically.