Male, 73 years old, with left leg weakness and rigidity of flexor muscles, hyperreflexic patella and Achilles, history of spinal stenosis. Alignment is anatomic. Vertebral body heights are preserved. No concerning areas of marrow replacement or marrow edema are detected. Foci of T1 and T2 hyperintensity within the L4 vertebral body likely represent benign hemangiomas.The spinal canal is congenitally slender to which prominent epidural fat contributes. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.L1-2: Mild disc bulging. No significant generalized canal stenosis. Mild bilateral foraminal narrowing. L2-3: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Facet of therapy. Ligamentum flavum thickening. Disc bulging with a right paracentral protrusion is seen contributing to a moderate generalized spinal canal narrowing with crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. No significant spinal canal narrowing. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy. Severe loss of disc height with mild disc bulging and osteophyte formation. No spinal canal stenosis. Mild bilateral foraminal narrowing.
Disc degeneration is evident at every level along with posterior element hypertrophy of the lower lumbar levels. These findings, along with a congenitally slender spinal canal, resulting in multilevel spinal canal stenosis. L3-4 is the most severely affected level where there is a moderate stenosis with crowding of the cauda equina.