72-year-old female with history of right lower extremity radicular symptoms. Evaluate for degenerative disc disease or neuroforaminal compromise. Exam is limited by patient's body habitus.Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild to moderate loss of disc height at L4-5 with vacuum phenomenon. There is a grade 1/2 anterolisthesis of L4 on L5 measuring approximately 9 mm. There is no definitive MR evidence of a pars defect. Bone marrow signal is benign. The conus medullaris is normal in position terminating at the level of L1-2. There is fatty atrophy of the right psoas and iliacus muscles. There is an incompletely imaged round T2 hyperintense lesion within the right aspect of the pelvis seen only at the edge of the sagittal series. Multilevel degenerative changes are seen, as described below:Sagittal images demonstrate a trace disc bulge at T10-11 and T11-12. L1-L2: No significant disc disease. Mild ligamentum flavum and facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.L2-L3: There are shallow foraminal disc protrusions encroaching on the neuroforamina. Mild ligamentum flavum and facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.L3-L4: Mild disc bulge with shallow bilateral foraminal disc protrusions and ligamentum flavum hypertrophy resulting in mild bilateral neuroforaminal stenosis. There is no significant spinal canal stenosis. L4-L5: There is disc bulge and uncovering with a superimposed central extrusion component extending 9 mm cranially. There is a central/right paracentral annular fissure which extends into the area of extruded disc. Additionally, there is ligamentum flavum and facet hypertrophy. These findings result in moderate spinal canal stenosis, moderate to severe neuroforaminal stenosis on the right and moderate neuroforaminal stenosis on the left. There is a left facet effusion.L5-S1: There is mild disc bulge with a left paracentral extrusion component extending 5 mm cranially as well as ligamentum flavum and facet hypertrophy resulting in mild left neuroforaminal narrowing. No significant spinal canal stenosis. There are bilateral facet joint effusions.
1. Grade 1/2 anterolisthesis of L4 on L5, degenerative in etiology, measuring approximately 9 mm with associated degenerative disc disease resulting in moderate spinal canal stenosis, moderate to severe right and moderate left neuroforaminal stenosis. No MR evidence of pars fracture.2. Advanced bilateral facet arthropathy at L4-5 and L5-S1.3. Partially imaged round T2 hyperintense lesion within the right aspect of the pelvis seen only at the edge of the sagittal series, but may relate to the right ovary. This is incompletely evaluated and correlation with dedicated pelvic ultrasound is recommended.