Male, 59 years old, with history of chronic lumbar pain and spinal stenosis. A dextroscoliosis of the lumbar spine is seen centered at L3-4. There may also be a slight anterolisthesis of L4 relative to L5. The L5 vertebral body demonstrates a transitional morphology.No evidence of concerning marrow replacement or significant marrow edema is seen. Degenerative endplate irregularity is pronounced at L3-4 and L4-5. All lumbar discs, with the exception of L5-S1, show some reduction in height and T2 signal intensity.Visualized spinal cord and conus are unremarkable. The nerve roots of the cauda equina are crowded at several levels due to degenerative disease and prominence of the epidural fat as detailed below.T12-L1: Facet hypertrophy. Right greater than left ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc asymmetric to the left. Prominence of the epidural fat. Generalized mild spinal canal narrowing with particular narrowing of the left lateral recess. Moderate bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Prominence of the epidural fat. Moderate generalized spinal canal narrowing with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Prominence of the epidural fat. Severe generalized canal stenosis with crowding of the cauda equina. Severe left and moderate right foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening, particularly on the left but there is a facet effusion . Bulging disc. Severe generalized spinal canal stenosis with crowding of the cauda equina. Severe bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Prominence of the epidural fat. Moderate spinal canal narrowing with some crowding of the cauda equina nerve roots. Severe right and moderate left foraminal narrowing.
1.Dextroscoliosis of the lumbar spine.2.Advanced disc degeneration at L3-4 and L4-5. Disc disease as well as posterior element hypertrophy and prominence of the epidural fat contribute to severe narrowing of the thecal sac and crowding of the cauda equina. Significant neuroforaminal narrowing is also evident at these levels.3.The remaining lumbar levels show a less severe reduction in spinal canal caliber, again due to disc degeneration, posterior element hypertrophy and prominence of the epidural fat.