Sciatica. Right calf pain and weakness on walking with reproducible distance. Resolves with rest. No pain when biking. Evaluate for spinal canal and neural foraminal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with focal fat or hemangiomas.. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Small synovial cyst is noted dorsal to the right facet joint.L4-L5: There is mild disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. Small bilateral facet effusions are noted. There is a 3 x 5 mm cystic structure likely representing a synovial cyst along the ligamentum flavum on the right which contributes to the spinal canal stenosis. There is moderate to severe spinal canal stenosis at this level. There is mild bilateral neural foraminal stenosis. Tiny cystic structure is also seen involving the left L4 lamina which may represent a subchondral cyst related to facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Prominence of the epidural fat. Thecal sac terminates just below this level.Paraspinous soft tissues are within normal limits.
Moderate to severe spinal canal stenosis at the L4-L5 level related to disc bulge, ligamentum flavum thickening, and facet arthropathy. There is a 3 x 5 mm synovial cyst on the right which also contributes to the stenosis.Mild bilateral neural foraminal stenosis at L4-L5. Otherwise no significant spinal canal or neural foraminal narrowing at the other levels.