68-year-old male with bilateral lower extremity weakness after a fall. Evaluate for etiology of the weakness. The vertebral column alignment is within normal limits. The vertebral body heights are preserved without evidence of fracture. There is multilevel disc desiccation involving the lower lumbar spine as well as severe disc height loss at the L3-4 and L5-S1 levels. At these levels there are endplate degenerative changes. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: Right greater than left disc bulge with mild right-sided neural foraminal stenosis. No left foraminal or spinal canal stenosis.L2-L3: Diffuse disc bulge with a small left paracentral disc protrusion which effaces the ventral thecal sac on the left and causes mild narrowing of the left lateral recess. There is also mild spinal canal stenosis and mild bilateral neural foraminal stenosis.L3-L4: Severe disc disease and disc bulge as well as facet hypertrophy which causes moderate bilateral neural foraminal and spinal canal stenosis. L4-5: Diffuse disc bulge with a left lateral annular fissure as well as facet arthropathy. There is no significant spinal canal or neural foraminal stenosis.L5-S1: Severe disc disease with lobular fatty material in the epidural space of the right anterior spinal canal at the L5-S1 level. The lesion abuts the disc and adjacent facet joint but does not clearly arise from either. Signal characteristics are entirely different from disc and there is no evidence of enhancement. This displaces the S1 nerve root posteriorly along with the other transiting sacral nerves. There are additional degenerative changes, a bulging disc with osteophyte formation and facet arthropathy which contributes to mild bilateral neural foraminal stenosis.
1.Lobular fatty material in the epidural space of the right anterior spinal canal at the L5-S1 level. The lesion abuts the disc and adjacent facet joint but does not clearly arise from either. Signal characteristics are entirely different from disc and there is no evidence of enhancement. This, along with additional degenerative changes, contributes to S1 nerve root displacement posteriorly along with the other sacral nerves. The differential includes a lipoma, dermoid cyst, or fatty degeneration of some other benign lesion.2.Severe disc disease and disc bulge at the L3-4 level as well as facet hypertrophy which causes moderate bilateral neural foraminal and spinal canal stenosis. 3.Diffuse disc bulge at the L2-3 level with a small left paracentral disc protrusion which effaces the ventral thecal sac on the left and causes mild narrowing of the left lateral recess. There is also mild spinal canal stenosis and mild bilateral neural foraminal stenosis at this level.