Back pain, radicular pain, evaluate for lumbar nerve root involvement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is dextro curvature of the upper lumbar spine better evaluated on recent radiographs. There is also minimal retrolisthesis of L1 on L2 and mild grade 1 anterolisthesis of L4 on L5. Bone marrow signal is benign with T1 hyperintense lesion involving L5 consistent with hemangioma. The conus medullaris is normal in position.Multilevel degenerative changes are seen including significant loss of disc height at the L1-L2 and L5-S1 levels and associated fatty endplate marrow signal changes. Individual levels as below: L1-L2: Disc bulge eccentric to the left and left-sided facet arthropathy result in mild left-sided neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.L2-L3: Disc bulge and bilateral facet arthropathy with minimal spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: Disc bulge with central protrusion, facet arthropathy, and ligamentum flavum thickening result in moderate to severe central spinal canal stenosis. There is minimal right and mild to moderate left neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis, disc covering and mild bulge, ligamentum flavum thickening, and advanced bilateral facet arthropathy. There is moderate to severe spinal canal stenosis. There is also moderate to severe bilateral, right worse than left neural foraminal stenosis which may be impinging on the bilateral L4 nerve roots.L5-S1: Disc bulge and mild facet arthropathy. No significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing.Paraspinous soft tissues are within normal limits.
Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is degenerative grade 1 anterolisthesis, moderate to severe spinal canal stenosis, and moderate to severe bilateral, right worse than left, neural foraminal stenosis. There is also moderate to severe spinal canal stenosis at the L3-L4 level. Additional levels as detailed above.