Low back pain [M54.5], Reason for Study: ^Reason: eval for cauda equina History: L spine tenderness, difficulty ambulating, incontinence For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Vertebral bone marrow signal on T1-weighted images show diffuse low signal intensity. At this age group, this diffuse low signal intensity on T1 weighted image indicate possible normal fatty marrow replacement such as chronic anemia, diffuse metastasis or other chronic illness, thus clinical correlation is indicated.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. L4-L5: Broad-based disc bulging towards left side neural foramen results mild left neuroforaminal stenosis. Focal enhancement of L4 inferior endplates may indicate possibility of focal end plate fracture, disc protrusion or focal Schmorl's node. CT scan can be considered for further imaging evaluation.L5-S1: The left side L5S1 facet joint shows bulky nature with linear and somewhat nodular signal voids indicate possible osteophytes formation likely due to localized facet arthritis which results left lateral recess stenosis associated with broad based disc bulge. Prominent epidural fat are seen at the level of L45 and L5S1 with mild to moderate spinal canal narrowing indicating epidural lipomatosis.
1. Diffuse decrease in bone marrow signal intensity on T1 weighted image may suggest associated systemic lesion such as chronic anemia, diffuse metastatic disease, or other bone marrow replacing lesions. Clinical correlation is recommended.2. Left side neuroforaminal stenosis as well as spinal canal narrowing likely due to epidural lipomatosis at the level of L45 and L5S1.3. Possible disc herniation or L4 inferior endplate fracture as well as possible left L5S1 facet hypertrophy, lumbar spine CT scan can be considered for further imaging evaluation if clinically indicated. 