Female, 35 years old, with pain radiating to the right lateral thigh and medial calf, then plantar medial. Tender right SI joint and paraspinous tissues at L2. Spinal alignment is anatomic. Vertebral body height is preserved. Degenerative endplate irregularity and signal change is seen at L5-S1, particularly on the left.Thickening of the cortex at the sacroiliac joints is seen, particularly on the right.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.T12-L1 through L3-4: Unremarkable.L4-5: Bilateral facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis.L5-S1: Bilateral facet arthropathy. Loss of disc height and mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.
1.Disc and posterior element degeneration are evident at L5-S1 but there is no significant spinal canal stenosis and only mild foraminal narrowing.2.Asymmetric sacroiliitis is suspected, right worse than left. The classic differential diagnosis for this finding would include psoriatic and reactive arthritis, along with other seronegative spondyloarthropathies and asymmetric osteoarthritis.