Left lower extremity radicular symptoms. Evaluate for spinal canal stenosis. Sagittal alignment is notable for 2 mm of anterior subluxation of L4 relative to L5, which is degenerative in nature. The vertebral bodies are preserved in height. Small fat-containing lesion is present at L4 vertebral body and is most compatible with a hemangioma. Two small lesions that are T1-hypointense, T2/STIR-hyperintense in L3 and L5 vertebral bodies may represent atypical hemangiomas. Additionally, there is type II degenerative signal change in the marrow subjacent to the anterior superior and inferior endplates of T12. There is lumbar disc desiccation and mild height loss, sparing L1-L2 disc. Multilevel degenerative facet disease is most pronounced in the lower lumbar spine at L4-L5 and L5-S1. The spinal canal is relatively preserved other than small ventral indentations by degenerative discs as described below. The conus medullaris is normal in signal and shape. The tip of the conus lies at L1-L2 level.T11-T12: Included only on sagittal imaging but there is no spinal canal stenosis and only mild bilateral foraminal stenosis.T12-L1 and L1-L2: There is mild facet arthropathy and ligamenta flava thickening but no spinal canal or neural foraminal stenosis.L2-L3: Disc bulge along with moderate facet arthropathy and ligamenta flava thickening result in minimal, if any, spinal canal stenosis and mild biforaminal stenosis without displacement of the nerve roots.L3-L4: Disc bulge flattens the anterior aspect of the thecal sac. Along with moderate facet arthropathy and ligamenta flava thickening, they result in mild central spinal canal stenosis. There is also left more than right mild-to-moderate subarticular recess and neural foraminal stenosis, without nerve displacement.L4-L5: There is a disc bulge that is eccentric to the right with a foraminal/extraforaminal component. There is also severe facet arthropathy with joint effusions as well as ligamenta flava thickening, with focal T2-hyperintensity on the left side, and possibly a small ligamentum flavum cyst. Combined, these result in mild central and right more than left subarticular recess stenoses. There is also moderate left and moderate-to-severe right neural foraminal stenoses with abutment of the of the extraforaminal segment of the right L4 nerve root by the disc.L5-S1: There is a left paracentral disc protrusion superimposed on bulging which posteriorly displaces and deforms the traversing left S1 nerve root. Severe left and moderate right facet arthropathy with subchondral cysts and tiny joint effusions along with bilateral ligamenta flava thickening result in left more than right moderate neural foraminal stenoses.
1.Multilevel spondylosis is most pronounced at L5-S1 where there is a left paracentral disc protrusion compressing the traversing left S1 nerve root. Severe left and moderate right facet arthropathy result in left more than right moderate neural foraminal stenosis as well.2.Degenerative disc and facets at L4-5 result in right more than left neural foraminal and subarticular recess stenoses as described above.3.Degenerative disease at the other levels is less pronounced as described above.