Thigh pain. Look for narrow for impingement. There is a mild, broad-based leftward convex lumbar curvature. Alignment is also notable for minimal anterior subluxation of L4 relative to L5 associated with facet proliferative disease. The intervening disc shows moderate loss of height and decreased T2 signal. In addition to uncovering, there is right paracentral disc protrusion. The marrow adjacent to the endplates show degenerative signal. The canal is moderately narrowed. Marrow signal is notable for fat-containing foci in the T11, T12, L3 and S1 bodies. It homogeneously suppresses on the STIR imaging.T12-L1 and L1-L2: There is no central or foraminal stenosis.L2-L3: Facet proliferative change is present but no central or foraminal stenosis.L3-L4: Disc bulge is associated with left paracentral sequestration and left foraminal protrusion. The sequestered fragment cranially migrates resulting in severe left subarticular recess stenosis while the protrusion causes severe left foraminal stenosis. Facet proliferative change and ligamenta flava buckling result in mild to moderate central canal narrowing as well.L4-L5: The subluxation is associated with disc uncovering and a cranially migrating central/right paracentral extrusion that results in severe right subarticular recess and right foraminal stenoses. There is mild left foraminal narrowing. Facet proliferative changes are slightly more pronounced on the left with excess joint fluid. Ligamenta flava thickening is also moderate to severe. Central narrowing is moderate.L5-S1: Severe bilateral facet productive changes result in severe bilateral foraminal stenosis. Ligamenta flava thickening mild. There is no central narrowing.
1.Multilevel degenerative disc disease and posterior element hypertrophy in the lower lumbar spine is most significant at L3-L4 (left sequestered paracentral disc fragment and left foraminal protrusion) and L4-L5 (central/right paracentral disc extrusion) and L5-S1 (foraminal stenoses) as described above.2.There is also multilevel spinal canal narrowing moderate at the L4-L5 and mild to moderate at L3-L4.