Systemic sclerosis. New onset bilateral lower extremity pain. The patient is also immunosuppressed. Thoracic Spine:There is exaggeration of the upper thoracic kyphosis though without significant anterior compression at any single level. Alignment is otherwise anatomic. There is no suspicious marrow focality. There is mild multilevel disc height and T2 signal loss. The discs at T2-T3, T3-T4, and T7-T8 cause shallow ventral thecal sac indentations as well as minimal indentation of the spinal cord. Less significant ventral thecal sac indentations are caused by the T8-T9 and T10-T11 discs without morphologic spinal cord abnormality. T10-T11 disc is associated with small interbody herniations but no edema. There is facet arthropathy multiple levels but without significant foraminal stenosis.The spinal cord shows normal signal. Following contrast administration, there is no abnormal spinal cord or leptomeningeal contrast enhancement.C7-T1 and T1-T2: There is no signal spinal canal or foraminal stenosis.T2-T3: There is a central component to the disc which minimally indents the spinal cord. There is no foraminal stenosis.T3-T4: There is a focal right paracentral component to the disc-osteophyte complex which minimally indents the spinal cord. There is no significant foraminal stenosis.T4-T5, T5-T6, and T6-T7: There is no significant spinal canal or foraminal stenosis.T7-T8: The disc-osteophyte complex is slightly more pronounced on the left causing minimal left paracentral indentation on the thecal sac. There is no significant foraminal stenosis.T8-T9: The disc-osteophyte complex has a very small central component minimally indenting the thecal sac. There is no central or foraminal stenosis.T9-T10, T10-T11, T11-T12 and T12-L1: There is no spinal canal or foraminal stenosis.Dependent lung opacities may represent atelectasis. The esophagus is more thick-walled and more open than expected which may reflect involvement by systemic sclerosis.Lumbar Spine:Alignment is notable for straightening which may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal is also without suspicious focality. The intervertebral discs are notable for mild T2 signal loss at L4-L5 and moderate height and T2 signal loss at L5-S1. Tip of the conus medullaris is at the L1-L2 level. The conus medullaris shows normal morphology and signal characteristics. The cauda equina nerve roots are normally distributed in the thecal sac. There are small anterior indentations of the thecal sac at L4-5 and L5-S1 due to discs as described below. Following contrast injection, there is no abnormal contrast enhancement along the conus or cauda equina roots.T12-L1, L1-L2 and L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild facet arthropathy.L3-L4: Disc bulge flattens the anterior aspect of thecal sac. There is also mild facet arthropathy. There is no significant spinal canal or foraminal stenosis.L4-5: Disc bulge is slightly eccentric to the left narrowing the left subarticular recess and abutting the traversing left L5 nerve root. There is left more than right facet arthropathy causing mild foraminal stenoses.L5-S1: There is a central disc extrusion which causes moderate left worse than right subarticular recess stenosis abutting traversing S1 nerve roots. There is also mild central spinal canal stenosis. This is associated with mild left worse than right foraminal stenoses. The disc extrusion is associated with contrast enhancement which is probably reactive.
1.Mild multilevel degenerative disease of the thoracic spine is present as described above. There is no significant spinal canal or foraminal stenosis.2.Lower lumbar degenerative spondylosis is most pronounced at L5-S1, where disc extrusion is abutting the S1 nerve roots. Please correlate with S1 radiculopathy, especially on the left. Milder degenerative disease is present at L4-5 as described above. Please correlate with left L5 radiculopathy.3.There is no abnormal spinal cord signal to suggest myelitis.