Diagnosis: Other spondylosis with radiculopathy, lumbar regionClinical question: disc herniation? foraminal/spinal stenosis?Signs and Symptoms: LBP radiating to LLE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There are low signal foci present within the L5 vertebral body which correspond to sclerotic change CT of the abdomen. From 7/30/2015 ,3/20 1/13 , 7/5/2011 and 4/3/2010 but less conspicuous on 6/19/2008At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation and a minor facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal. There is a right far lateral disc protrusion present at this level which encroaches on the right-sided exiting nerve root within the neural foramen.At L3-4 there is loss of disc space height, endplate reactive change and disc desiccation associated with mild anterior subluxation of L3 on L4 there is ligamentum flavum hypertrophy present bilaterally at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. There is a cystic lesion along the posterior aspect of the spinal canal contiguous with the left facet joint at this level most likely representing synovial cyst. There is no significant spinal canal stenosis at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Multiple small cystic lesions are present in the kidneys.
1.There are degenerative changes present in the lumbar spine with mild subluxation at L3-4 where there is also a synovial cyst and some mild encroachment of the exiting nerve roots within the neural foramina.2.There is a right far lateral disc protrusion at L4-5 which encroaches on the right-sided exiting nerve root within the neural foramen at this level.3.A sclerotic focus within the L5 vertebral body which hasn't present since CT scan from 4/13/2010 but was less conspicuous prior to that time. Although this could be degenerative patient has known prostate cancer metastatic disease may have a similar appearance. A bone scan would be able to help further assess it for metabolic activity.