Female, 66 years old, with right hip pain. History of synovial cyst in 2013. Spinal alignment is anatomic. Vertebral body height and morphology are normal. No pathologic marrow replacement or edema is detected.The visualized distal spinal cord, conus and cauda equina nerve roots are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Ligamentum flavum thickening. Minimal lateral disc bulging. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy. Ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L4-5: Advanced facet arthropathy. Bulging disc. A cystic lesion measuring up to 10 mm in diameter is evident within the right aspect of the spinal canal spanning the subarticular and lateral recesses and located primarily above the level of the disc space. This lesion appears to be more closely associated with the adjacent degenerated facet than with the disc. The lesion causes effacement of the right aspect of the thecal sac with medial displacement of nerve roots and possible impingement of the exiting right L4 nerve root. The neural foramina are mildly narrowed by facet degeneration. L5-S1: Facet arthropathy. Mild bulging disc. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing.
1.A cystic lesion is evident within the right aspect of the spinal canal at L4-5 causing effacement of the right subarticular and lateral recesses. This is favored to represent a synovial cyst rather than a sequestered disk herniation. This lesion causes leftward deviation of the cauda equina and may impinge the exiting right L4 nerve root.2.Sequelae of prior facetotomy are seen on the left at L4-5.3.No other significant spinal canal or foraminal stenosis is detected.