Male, 40 years old, with pain from calf to lateral foot, weakness of great toe dorsiflexion. Eval for L5 or S1 nerve root impingement. Assuming the vertebral body with rudimentary ribs to be T12, there are four fully lumbar vertebral bodies and a transitional L5. Spinal alignment is anatomic. Vertebral body heights are preserved. A 1 cm T2 hyperintense focus in the L3 vertebral body is favored to represent a benign process, perhaps an atypical hemangioma. The visualized distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected. L1-2: Loss of disc T2 signal, but preserved disc height. Small left paracentral superiorly directed extrusion. No significant canal stenosis or nerve root impingement. No foraminal narrowing. L2-3: Unremarkable. L3-4: Small right subarticular disc protrusion which mildly contacts the descending right L4 nerve root. No significant canal stenosis. Mild right foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc T2 signal and slight loss of disc height. Shallow central disc protrusion. No significant canal stenosis. Mild foraminal narrowing. L5-S1: Perineural root sleeve cyst along the right exiting L5 nerve root. No spinal canal or foraminal narrowing.
Mild degenerative findings are seen. At L3-4, a small right subarticular disc protrusion contacts the descending right L4 nerve root. At L5-S1, note is made of a perineural root sleeve cyst along the exiting right L5 nerve root, though these cysts are a common incidental finding of questionable significance. No other significant spinal canal or foraminal encroachment is seen. 