76-year-old female with low back pain and question of disc herniation or nerve impingement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 retrolisthesis of L5 on S1 and trace anterolisthesis of L3 on L4. Bone marrow signal is benign. The conus medullaris is normal in position between L1 and L2.Multilevel degenerative changes are seen, as described below:T12-L1: Minimal right paracentral disc protrusion. No spinal canal or neural foraminal stenosis. No significant facet hypertrophy.L1-L2: Minimal right-sided disc bulge. No spinal canal or neural foraminal stenosis. Right greater than left facet hypertrophy and ligamentum flavum thickening. The right neuroforamen is narrowed.L2-L3: Right-sided disc bulge. No spinal canal stenosis. Bilateral facet hypertrophy and ligamentum flavum thickening. Mild right neuroforaminal stenosis.L3-L4: Generalized disc bulge with a superimposed right inferior paracentral disc protrusion. The cauda equina is mild to moderately crowded at this level secondary to ligamentum flavum thickening and bilateral facet hypertrophy. There is mild bilateral neural foraminal stenoses.L4-L5: Trace retrolisthesis of L4 on L5. This retrolisthesis causes some uncovering of the disc and crowding of the cauda equina. There is also an annular fissure posteriorly. There is severe left greater than right facet hypertrophy that causes moderate right neural foraminal stenosis and severe left neural foraminal stenosis. L5-S1: Grade 1 retrolisthesis of L5 on S1 causes disc uncovering and crowding of the cauda equina. There is moderate bilateral facet hypertrophy with severe bilateral neural foraminal stenoses.Apparent redundancy of the sigmoid colon within the pelvis is visualized.
1. Trace retrolisthesis of L4 on L5 and grade 1 retrolisthesis of L5 on S1.2. Extensive spondylotic changes described by level above. These include crowding of the cauda equina and neural foraminal stenoses most severe at L4-L5 and L5-S1.