81-year-old male with severe low back pain including paresthesias and weakness. For the purpose of labeling, 5 lumbar vertebral bodies are assumed to be present with the lower-most level containing a well-formed disc and numbered as L5/S1. This is the same nomenclature as utilized previously.The conus medullaris is located at level of L1 -- L2 and is normal in appearance.Degenerative disease is seen in the lumbar spine. The degenerative changes at individual levels are as follows:T12-L1: There are disk bulging and facet arthropathic changes, resulting in mild spinal canal stenosis and neural foraminal narrowing, unchanged.L1-L2: There is diffuse disk bulging, severe facet hypertrophy, and ligament flavum thickening, resulting in severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged.L2-L3: There is diffuse disk bulging, severe facet hypertrophy, and ligament flavum thickening, resulting in severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged.L3-L4: There is grade 1 anterolisthesis of L3 over L4, diffuse disk bulging, severe facet hypertrophy, and ligament flavum thickening, resulting in severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged. Bilateral facet effusions appear smaller.L4-L5: There is grade 1 retrolisthesis of L4 over L5, disk bulging with posterior osteophyte, severe facet hypertrophy, and ligament flavum thickening, resulting in moderate to severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged.L5-S1: There are new T2 hyperintense reactive endplate changes consistent with evolving Modic type I reaction (best seen with sagittal STIR technique). There is disk bulging and posterior osteophyte, severe facet hypertrophy, and ligament flavum thickening, resulting in mild spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. Other than the new Modic type I reactive endplate changes, the other described findings are unchanged.
Severe degenerative disease of the lumbar spine, with high-grade spinal canal stenosis at multiple levels. There are also lateral recess and neural foraminal stenoses at multiple levels. However, these stenotic changes are stable in appearance. 